1407148752 NPI number — LI WEI WONG BCBA

Table of content: LI WEI WONG BCBA (NPI 1407148752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407148752 NPI number — LI WEI WONG BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WONG
Provider First Name:
LI
Provider Middle Name:
WEI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407148752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 S MENTOR AVE
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91106-2936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-597-4864
Provider Business Mailing Address Fax Number:
626-768-7785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 S MENTOR AVE
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91106-2936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-597-4864
Provider Business Practice Location Address Fax Number:
626-768-7785
Provider Enumeration Date:
05/04/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-09-5203 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)