Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A114159 | CA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | A114159 | CA |
NPI | 1356584007 |
---|---|
Provider Name | Wendy Wan Wong |
First Address | Walnut Creek, CA 94598-8396 |
Second Address | Walnut Creek, CA 94598-5906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2009 |
Last Update Date | 15/12/2020 |