Organization
CONNIE WONG, DPM AND KI SANG YI, DPM INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIV BUNLEUTH (BILLING MANAGER)
(562) 234-3174
Entity
Organization
Contact information
Practice address
1703 TERMINO AVE, SUITE 103, LONG BEACH, CA 90804-2124
(562) 597-5100
(562) 597-5165
Mailing address
1703 TERMINO AVE, SUITE 103, LONG BEACH, CA 90804-2124
(562) 597-5100
(562) 597-5165
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033120118
NPI
CA
01
—
1295746345
NPI
CA
Enumeration date
08/01/2011
Last updated
03/19/2020
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