Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 11463R | LA |
Y | 2084N0402X | Child Neurologist | 11463R | LA |
NPI | 1346262128 |
---|---|
Provider Name | Joaquin Wong |
First Address | New Orleans, LA 70118 |
Second Address | New Orleans, LA 70118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 12/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00118507 | (05) | MS |
1664472 | (05) | LA |
G08548 | (02) | |
G08548 | (02) | LA |