Ellis C. Wong,DDS,Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

29004 Issued in CA

Legal business name

ELLIS C. WONG,DDS,INC.

Practice address

607 N Larchmont Blvd
Los Angeles, CA 90004-1307

Phone

(323) 464-5555

Fax

(323) 464-3075

NPI assigned

Apr 26, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ellis Charles Wong, DDSNPI 1316167711

Title

President

Phone

(323) 464-5555

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ellis Charles Wong, DDS

  • General Practice Dentistry
  • Los Angeles, CA
  • NPI 1316167711
  NPD (past) Authorized official
• Cynthia Rangel, DDS

  • Dentist
  • Los Angeles, CA
  • NPI 1295513356
  NPD (past)

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447470844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 N LARCHMONT BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900041307",
            "telephone_number": "323-464-5555",
            "fax_number": "323-464-3075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 N LARCHMONT BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900041307",
            "telephone_number": "323-464-5555",
            "fax_number": "323-464-3075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIS C. WONG,DDS,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "ELLIS",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-464-5555",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "29004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert William Elliott, PSYCHOLOGIST
• Terry Elliott, PA-C
• Tiffany Elliott, DDS
• Tiffany Kay Elliott
• Tomas Elliott
• Ellis Effect Psychological Group, Inc (Ellis Effect)
• Brandon Ellis Jr
• Edward Errol Ellis-Compton
• Alissa J Ellis, PHD
• Amber Ellis

• General Practice Dentistry in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.