Organization Active NPI

Connie Wong, DPM and Ki Sang Yi, DPM Inc

  • Foot & Ankle Surgery Podiatrist
  • Long Beach, CA
National Provider Identifier
1346528908
Registry record updated Mar 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
CONNIE WONG, DPM AND KI SANG YI, DPM INC
Practice address
1703 Termino Ave
Suite 103
Long Beach, CA 90804-2124
Phone
(562) 597-5100
Fax
(562) 597-5165
NPI assigned
Aug 1, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2020

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

Authorized official

Name
Tiv Bunleuth
Title
Billing Manager
Phone
(562) 234-3174

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X Primary

Addresses

Primary practice location

1703 Termino Ave
Suite 103
Long Beach, CA 90804-2124

Mailing address

1703 Termino Ave
Suite 103
Long Beach, CA 90804-2124
Phone (562) 597-5100

Other identifiers 2

IdentifierTypeStateIssuer
1295746345OtherCANPI
1033120118OtherCANPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110831000478 CA DME Supplier - Physician - Podiatry 2163628082 Practice locations: Long Beach, CA

National Provider Directory

National Provider Directory

Locations

915 Redondo Ave
Long Beach, CA 90804
Phone (562) 432-8991

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1312156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584576000000",
    "number": "1346528908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1703 TERMINO AVE",
            "address_2": "SUITE 103",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908042124",
            "telephone_number": "562-597-5100",
            "fax_number": "562-597-5165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 TERMINO AVE",
            "address_2": "SUITE 103",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908042124",
            "telephone_number": "562-597-5100",
            "fax_number": "562-597-5165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNIE WONG, DPM AND KI SANG YI, DPM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-01",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A",
        "authorized_official_last_name": "BUNLEUTH",
        "authorized_official_first_name": "TIV",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "562-234-3174"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1295746345",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1033120118",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.