Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 30131 | CA |
NPI | 1013184498 |
---|---|
Provider Name | Dr. Jeffrey Y Wong |
First Address | Fremont, CA 94539-7957 |
Second Address | Fremont, CA 94539-7957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2008 |
Last Update Date | 14/05/2008 |