Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 58648 | CA |
NPI | 1083847578 |
---|---|
Provider Name | Dr. Becky Wah Rong Gong |
First Address | Cupertino, CA 95014 |
Second Address | Cupertino, CA 95014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2009 |
Last Update Date | 18/07/2018 |