Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | G56823 | CA |
NPI | 1043300742 |
---|---|
Provider Name | Dr. Wade Kingery |
First Address | Palo Alto, CA 94304-1207 |
Second Address | Palo Alto, CA 94304-1207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 08/07/2007 |