Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 299881 | CA |
NPI | 1053903328 |
---|---|
Provider Name | Katrina Lee Wong |
First Address | Los Altos, CA 94024-6054 |
Second Address | Los Altos, CA 94024-6054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2021 |
Last Update Date | 09/02/2021 |