Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A87388 | CA |
N | 111NI0900X | Internist | A87388 | CA |
Y | 207RC0000X | Internist - Cardiovascular Disease | A87388 | CA |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | A87388 | CA |
NPI | 1013029065 |
---|---|
Provider Name | Dr. Jennifer L Wong |
First Address | Fountain Valley, CA 92708-6728 |
Second Address | Fountain Valley, CA 92708-6728 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 15/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013029065 | (05) | CA |