Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 086848 | CA |
NPI | 1134322712 |
---|---|
Provider Name | Mrs. Joanna Wong |
First Address | Monterey Park, CA 91755-3045 |
Second Address | Monterey Park, CA 91755-3045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 08/07/2007 |