| Grace Wong Md Inc | |
|
3808 W Riverside Dr Ste 201 Burbank CA 91505-4339 | |
| (818) 563-1449 | |
| Not Available |
| Full Name | Grace Wong Md Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3808 W Riverside Dr Ste 201, Burbank, California |
| Authorized Official Name and Position | Grace Wong (PRESIDENT) |
| Authorized Official Contact | 6263479074 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Wong Md Inc 3808 W Riverside Dr Ste 201 Burbank CA 91505-4339 Ph: (626) 347-9074 | Grace Wong Md Inc 3808 W Riverside Dr Ste 201 Burbank CA 91505-4339 Ph: (818) 563-1449 |
| NPI Number | 1659648384 |
|---|---|
| Provider Enumeration Date | 11/23/2011 |
| Last Update Date | 12/28/2023 |
| Medicare PECOS PAC ID | 5597931378 |
|---|---|
| Medicare Enrollment ID | O20111228000434 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659648384 | NPI | - | NPPES |
| 1053504902 | Other | CA | TYPE 1 NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A96700 (California) | Primary |
| Provider Name | Grace I Wong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053504902 PECOS PAC ID: 0446344188 Enrollment ID: I20090311000581 |
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