Active NPI
Katherine A Wong, D.D.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- El Monte, CA
National Provider Identifier
1093179665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 63341
- Practice address
- 11008 Valley Mall
Suite 203
El Monte, CA 91731-2645 - Phone
- (844) 757-9799
- NPI assigned
- Apr 11, 2016
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 63341 | CA | Primary |
Addresses
Primary practice location
11008 Valley Mall
Suite 203
El Monte, CA 91731-2645
Mailing address
12799 Texana St
San Diego, CA 92129-3616
Phone (858) 472-2716
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170530000423 | CA | Order and Referring Only - Other (Physician) | 6305113127 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63341 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1460332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460332800000",
"number": "1093179665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12799 TEXANA ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921293616",
"telephone_number": "858-472-2716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11008 VALLEY MALL",
"address_2": "SUITE 203",
"city": "EL MONTE",
"state": "CA",
"postal_code": "917312645",
"telephone_number": "844-757-9799"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "KATHERINE",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-04-11",
"last_updated": "2016-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "CA",
"license": "63341",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Monte, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.