Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 25108DN32 | WA |
NPI | 1205080009 |
---|---|
Provider Name | Kam Wong |
First Address | Seattle, WA 98116-4116 |
Second Address | Seattle, WA 98116-4116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2008 |
Last Update Date | 06/11/2008 |