Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 63956 | CA |
Y | 213EG0000X | General Practice | 63956 | CA |
NPI | 1003216110 |
---|---|
Provider Name | Dr. Steven Kenneth Wong |
First Address | Vacaville, CA 95687-9483 |
Second Address | Cerritos, CA 90703-9242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2014 |
Last Update Date | 26/08/2014 |