Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | A24840 | CA |
NPI | 1053408435 |
---|---|
Provider Name | Dr. Ing L Wong |
First Address | Los Alamitos, CA 90720 |
Second Address | Los Alamitos, CA 90720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 09/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00248400 | (05) | CA |
A24154 | (02) |