Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 0101272195 | VA |
NPI | 1427444579 |
---|---|
Provider Name | Stephanie Jung-Ying Wong |
First Address | Rochester, NY 14642-8629 |
Second Address | Rochester, NY 14642-8629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2015 |
Last Update Date | 09/12/2021 |