Individual
DR. RYAN LEE WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
10833 LE CONTE AVE, B0-130 CHS, LOS ANGELES, CA 90095-1668
(310) 825-3795
(310) 825-9653
Mailing address
22287 MULHOLLAND HWY # 149, CALABASAS, CA 91302-5157
(818) 424-8536
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
104808
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2017
Last updated
12/02/2021
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