Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 4301073055 | MI |
Y | 207U00000X | Nuclear Medicine Specialist | C144795 | CA |
NPI | 1396705356 |
---|---|
Provider Name | Ching Yee Wong |
First Address | Sacramento, CA 95815-4227 |
Second Address | Sacramento, CA 95815-4227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 09/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010F362410 | BCBSM (01) | MI |
3521647 | (05) | MI |
D40444 | (02) | MI |