Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 12585 | CA |
NPI | 1003959180 |
---|---|
Provider Name | Ms. Pauline Fue Wong |
First Address | Berkeley, CA 98705 |
Second Address | Berkeley, CA 98705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |