Provider Demographics
NPI:1164240313
Name:WONG, KRISTINE (MS, RDN)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W LEMON AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5112
Mailing Address - Country:US
Mailing Address - Phone:626-268-1353
Mailing Address - Fax:626-231-0616
Practice Address - Street 1:50 W LEMON AVE STE 8
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-5112
Practice Address - Country:US
Practice Address - Phone:626-268-1353
Practice Address - Fax:626-231-0616
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86296981133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered