Individual
DR. KING YUE WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1431 7TH ST, SUITE # 201, SANTA MONICA, CA 90401-2637
(310) 395-2106
(310) 450-8580
Mailing address
316 S KENTER AVE, LOS ANGELES, CA 90049-4022
(310) 471-9618
(310) 450-8580
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OPT12461TPA
CA
152WL0500X
Low Vision Rehabilitation Optometrist
OPT12461TPA
CA
152WP0200X
Pediatric Optometrist
Primary
OPT12461TPA
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1871678557
NPI # (ORGANIZATION & GROUP)
CA
05
—
SD0124610
—
CA
01
—
SD0124611
MEDICAID (2ND OFFICE)
CA
Enumeration date
02/01/2010
Last updated
02/01/2010
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