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Organization
LA VERNE FAMILY MEDICAL CENTER INC
Active
Organization
LA VERNE FAMILY MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAN LIN WONG MD (PRESIDENT)
(909) 596-1941
Entity
Organization
Contact information
Practice address
2100 FOOTHILL BLVD, SUITE A, LA VERNE, CA 91750-2905
(909) 596-1941
(909) 596-1943
Mailing address
2100 FOOTHILL BLVD, SUITE A, LA VERNE, CA 91750-2905
(909) 596-1941
(909) 596-1943
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A50496
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W20443
MEDICARE GROUP ID
CA
Enumeration date
08/27/2006
Last updated
12/09/2011
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