Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN27707 | CA |
NPI | 1033260534 |
---|---|
Provider Name | Norman Gong Wat |
First Address | Fremont, CA 94536-3800 |
Second Address | Fremont, CA 94536-3800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DN27707 | DENTAL LICENCE NUMBER (01) | CA |