Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013036938 |
---|---|
Provider Name | Jane Wong |
First Address | Rosemead, CA 91770-1934 |
Second Address | Rosemead, CA 91770-1934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 02/08/2013 |