Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 11927 | CT |
NPI | 1003321514 |
---|---|
Provider Name | Kit Ling Wong |
First Address | Flushing, NY 11358-4115 |
Second Address | Stamford, CT 06901-1636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2017 |
Last Update Date | 06/12/2017 |