Kelly Tim Tim Wong, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A10595 Issued in CA

Practice address

500 N Garfield Ave Ste 105
Monterey Park, CA 91754-1242

Phone

(626) 288-3828

Fax

(626) 573-8513

NPI assigned

Feb 21, 2008

Last updated

Jan 12, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Western University of Health Sciences College of Dental Med, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kelly Wong DO Inc

  • Primary Care Clinic/Center
  • Monterey Park, CA
  • NPI 1427361617
  Medicare reassignment NPD Authorized official
• Dr. Tin S Wong DO Medical Corporation

  • Health Service Clinic/Center
  • Los Angeles, CA
  • NPI 1811449598
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705017600000",
    "number": "1215106448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N GARFIELD AVE STE 105",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917541242",
            "telephone_number": "626-288-3828",
            "fax_number": "626-573-8513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N GARFIELD AVE STE 105",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917541242",
            "telephone_number": "626-288-3828",
            "fax_number": "626-573-8513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "KELLY",
        "middle_name": "TIM TIM",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-02-21",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A10595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cong-Bong Biu Wong, OTD, OTR/L
• Irene L Wong, L.AC
• Jason C Wong, MD
• Joanna Wong
• Josephine Meifang Wong, RD
• Lai Yee Wong
• Lapting Wong, RDN
• Maricres Lew Wong, MSW
• Mary SK Wong, LIC. AC.
• Melissa Susan Wong

• Family Medicine Physician in Monterey Park, CA
• Providers in Monterey Park, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.