Organization
CARSON FOOT CLINIC A PODIATRIST GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BUU KIM WONG DPM (PRESIDENT)
(310) 518-3972
Entity
Organization
Contact information
Practice address
500 E CARSON ST, STE 112, CARSON, CA 90745-2713
(310) 518-3972
(310) 518-3998
Mailing address
500 E CARSON ST, STE 112, CARSON, CA 90745-2713
(310) 518-3972
(310) 518-3998
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E2351
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E23510
—
CA
Enumeration date
09/07/2005
Last updated
08/22/2020
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