Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | G63765 | CA |
NPI | 1073684973 |
---|---|
Provider Name | Rose Sui Lan Wong |
First Address | Downey, CA 90242-2814 |
Second Address | Bellflower, CA 90706-2246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 01/12/2021 |