Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | A117618 | CA |
NPI | 1215191846 |
---|---|
Provider Name | Denise Rae Wong |
First Address | San Francisco, CA 94132-1911 |
Second Address | San Francisco, CA 94132-1911 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2008 |
Last Update Date | 18/09/2014 |