Provider Demographics
NPI:1962806042
Name:WONG, GINA HU (PT, DPT, OCS)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:HU
Last Name:WONG
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:Y
Other - Last Name:HU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:15446 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-4319
Mailing Address - Country:US
Mailing Address - Phone:310-217-5400
Mailing Address - Fax:
Practice Address - Street 1:15446 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4319
Practice Address - Country:US
Practice Address - Phone:310-217-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41546OtherPHYSICAL THERAPY BOARD OF CALIFORNIA