Active NPI
Stephanie Wong, MD
- Otolaryngology Physician
- Los Angeles, CA
National Provider Identifier
1659020295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- PTL9463
- Practice address
- 2051 Marengo St Ste A7D
Los Angeles, CA 90033-1352 - Phone
- (310) 872-7262
- NPI assigned
- Mar 21, 2022
- 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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | PTL9463 | CA | Primary |
Addresses
Primary practice location
2051 Marengo St Ste A7D
Los Angeles, CA 90033-1352
Mailing address
2051 Marengo St Ste A7D
Los Angeles, CA 90033-1352
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240603001747 | CA | Order and Referring Only - Otolaryngology | 3476095738 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTL9463 | CA | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719619200000",
"number": "1659020295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2051 MARENGO ST STE A7D",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900331352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2051 MARENGO ST STE A7D",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900331352",
"telephone_number": "310-872-7262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "STEPHANIE",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-03-21",
"last_updated": "2024-06-29",
"certification_date": "2024-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "CA",
"license": "PTL9463",
"primary": true
}
],
"identifiers": [],
"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 Jun 29, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.