Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MD00039410 | WA |
NPI | 1053486415 |
---|---|
Provider Name | Dr. Michelle Fong Zhong |
First Address | Tacoma, WA 98409-7324 |
Second Address | Tacoma, WA 98409-7324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 29/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8288839 | (05) | WA |
H42366 | (02) | WA |