Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | G78666 | CA |
NPI | 1235114703 |
---|---|
Provider Name | Dr. Michael Sheldon Wong |
First Address | Sacramento, CA 95817-1418 |
Second Address | Sacramento, CA 95817-1418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 10/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G78666 | MEDICAL LICENSE (01) | CA |
H61721 | (02) | CA |