Suzie Malaca Wong, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

45997 Issued in CA

Practice address

18527 S Western Ave
Suite 16
Gardena, CA 90248-3830

Phone

(310) 532-2774

Fax

(310) 532-7174

NPI assigned

Jul 27, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective May 19, 2023 through May 19, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Suzie M. Wong DDS, Inc

  • Dentist
  • Gardena, CA
  • NPI 1194901074
  NPD (past) Authorized official

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1538173554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18527 S. WESTERN AVE.",
            "address_2": "SUITE 16",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "90248",
            "telephone_number": "310-532-2774",
            "fax_number": "310-532-7174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18527 S WESTERN AVE",
            "address_2": "SUITE 16",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902483830",
            "telephone_number": "310-532-2774",
            "fax_number": "310-532-7174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "SUZIE",
        "middle_name": "MALACA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "45997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darren Wong
• Eugene K Wong, PHARM. D
• Gina Hu Wong, PT, DPT, OCS
• Kasin Wong
• Natalie Wong
• Aimee Sarahi Wood
• Ryan Wood
• Cheryl R Woodruff, INTERN MFT
• Lahya Woodruff, M.SLP
• Darrell Romaine Woods, CAS

• General Practice Dentistry in Gardena, CA
• Providers in Gardena, 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 Jul 8, 2007; 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.

Verify at the official NPI Registry.