Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | C50840 | |
N | 222Z00000X | Podiatrist | C50840 | |
Y | 224P00000X | Prosthetist | C50840 |
NPI | 1245705805 |
---|---|
Provider Name | Jason Frank Wong |
First Address | Sacramento, CA 95823-5928 |
Second Address | Sacramento, CA 95823-5928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2018 |
Last Update Date | 10/10/2018 |