Active NPI
Wan Wong
- Pharmacist
- Baldwin Park, CA
National Provider Identifier
1073053872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 49764
- Practice address
- 1011 Baldwin Park Blvd
Baldwin Park, CA 91706-5806 - Phone
- (626) 851-5552
- NPI assigned
- Feb 28, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 49764 | CA | Primary |
Addresses
Primary practice location
1011 Baldwin Park Blvd
Baldwin Park, CA 91706-5806
Mailing address
1249 S Diamond Bar Blvd
242
Diamond Bar, CA 91765-4122
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49764 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1488240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488240000000",
"number": "1073053872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1249 S DIAMOND BAR BLVD",
"address_2": "242",
"city": "DIAMOND BAR",
"state": "CA",
"postal_code": "917654122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1011 BALDWIN PARK BLVD",
"city": "BALDWIN PARK",
"state": "CA",
"postal_code": "917065806",
"telephone_number": "626-851-5552"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "WAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-02-28",
"last_updated": "2017-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "49764",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baldwin Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.