Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | A91426 | CA |
NPI | 1841214376 |
---|---|
Provider Name | Cynthia Wong |
First Address | Stanford, CA 94305-5208 |
Second Address | Stanford, CA 94305-5208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |