Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC29024 | CA |
NPI | 1003275215 |
---|---|
Provider Name | Mr. Adam Han Wong |
First Address | San Jose, CA 95148 |
Second Address | San Jose, CA 95112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2016 |
Last Update Date | 16/02/2016 |