Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 0101248756 | VA |
Y | 207K00000X | Allergist & Immunologist | A159362 | CA |
N | 208000000X | Pediatrician | 0101248756 | VA |
N | 208000000X | Pediatrician | A159362 | CA |
NPI | 1134353949 |
---|---|
Provider Name | Dr. Priscilla H Wong |
First Address | Stanford, CA 94305-2200 |
Second Address | Atherton, CA 94027-3802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2009 |
Last Update Date | 19/09/2019 |