Active NPI
Theresa Wong
- Geriatric Medicine (Internal Medicine) Physician
- Pasadena, CA
National Provider Identifier
1215469176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician
- License
- A159265
- Practice address
- 800 Fairmount Ave
Pasadena, CA 91105-3150 - Phone
- (626) 765-5636
- NPI assigned
- Mar 30, 2017
- Last updated
- May 11, 2024
- 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 |
|---|---|---|---|---|
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | A159265 | CA | Primary |
Addresses
Primary practice location
800 Fairmount Ave
Pasadena, CA 91105-3150
Mailing address
621 Camino Cerrado
South Pasadena, CA 91030-4103
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 25, 2024 through Mar 25, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A159265 | CA | MD | Geriatric Medicine (Internal Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715385600000",
"number": "1215469176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "621 CAMINO CERRADO",
"city": "SOUTH PASADENA",
"state": "CA",
"postal_code": "910304103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 FAIRMOUNT AVE",
"city": "PASADENA",
"state": "CA",
"postal_code": "911053150",
"telephone_number": "626-765-5636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "THERESA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-30",
"last_updated": "2024-05-11",
"certification_date": "2024-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "CA",
"license": "A159265",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.