Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 21175DC | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 21175DC | CA |
NPI | 1306168711 |
---|---|
Provider Name | Dr. William Ieng Wong |
First Address | Temple City, CA 91780-1852 |
Second Address | Temple City, CA 91780-1852 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2010 |
Last Update Date | 26/02/2010 |