Individual provider Active NPI

Melissa Wong, DPT

  • Physical Therapist
  • Los Angeles, CA
National Provider Identifier
1225452030
Registry record updated Jul 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40873 Issued in CA
Practice address
1503 Lake Shore Ave
Los Angeles, CA 90026-2531
Phone
(415) 819-7866
NPI assigned
Feb 13, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 40873 CA Primary

Addresses

Primary practice location

1503 Lake Shore Ave
Los Angeles, CA 90026-2531

Mailing address

1503 Lake Shore Ave
Los Angeles, CA 90026-2531

Other practice location 1

6080 Center Dr Fl 6
Los Angeles, CA 90045-9205
Phone (888) 859-0145

Other identifiers 1

IdentifierTypeStateIssuer
1689563637OtherNPPES

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20151118000706 NY Practitioner - Physical Therapist in Private Practice 5193025401 Reassigns benefits to 1 organization
I20221117000933 CA Practitioner - Physical Therapist in Private Practice 5193025401 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
California Luna Care Physical Therapy PCGroup PAC ID 9638427834, 769 clinicians
Kulagy Physical Therapy PCGroup PAC ID 9638459621, 17 clinicians

Practice addresses (Care Compare)

16185 Los Gatos Blvd
Suite 205
Los Gatos, CA 95032-4569
Phone (866) 525-3175

6060 Ctr Dr
FL 10
Los Angeles, CA 90045-1598
Phone (888) 859-0145

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40873CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
California Luna Care Physical Therapy PC Physical Therapist CurrentSince Jan 30, 2026 Accepting new patients
Physioflow CurrentSince Jul 9, 2025 Accepting new patients
S2 Physical Therapy P.C. Physical Therapist CurrentSince Oct 1, 2022 Accepting new patients
Holt Chiropractic Offices, P.C. Past Accepting new patients
Lenox Hill Radiology & Medical Imaging Associates, PC PastSince Nov 2, 2015 Accepting new patients

Locations

16185 Los Gatos Blvd
Ste 205
Los Gatos, CA 95032
Phone (408) 459-8108

1 Bridge St
Ste 71
Irvington, NY 10533
Phone (914) 375-3434

1995 Broadway
Fl 15
New York, NY 10023
Phone (212) 712-2006

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1392249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752537600000",
    "number": "1225452030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 LAKE SHORE AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900262531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1503 LAKE SHORE AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900262531",
            "telephone_number": "415-819-7866"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6080 Center Dr Fl 6",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900459205",
            "country_code": "US",
            "telephone_number": "888-859-0145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WONG",
        "first_name": "MELISSA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-13",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "40873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1689563637",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.