Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 13102 | CA |
NPI | 1639589435 |
---|---|
Provider Name | Dr. Cong-Bong Biu Wong |
First Address | Monterey Park, CA 91755-3102 |
Second Address | Monterey Park, CA 91755-3102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2014 |
Last Update Date | 01/05/2014 |