Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | MD60749734 | WA |
NPI | 1023436938 |
---|---|
Provider Name | Alina Borisovna Wong |
First Address | Salt Lake City, UT 84125-0608 |
Second Address | Issaquah, WA 98029-6201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2014 |
Last Update Date | 21/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023436938 | (05) | WA |