Individual
MR. DOMINIC TAN WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
GNP-BC
Contact information
Practice address
13652 CANTARA ST, BALBOA PLAZA BLDG, PANORAMA CITY, CA 91402-5423
(818) 832-7287
(818) 250-0061
Mailing address
15971 THOMPSON RANCH DRIVE, SANTA CLARITA, CA 91387
(818) 288-2373
(661) 251-1681
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
587716
CA
163W00000X
Registered Nurse
RN 587716
CA
163WG0600X
Gerontology Registered Nurse
NP 15170
CA
363L00000X
Nurse Practitioner
Primary
15170
CA
363LG0600X
Gerontology Nurse Practitioner
15170
CA
Other
Enumeration date
07/03/2006
Last updated
02/16/2023
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