1437579109 NPI number — MR. DAVID YICK LEUNG WONG ATC

Table of content: MR. DAVID YICK LEUNG WONG ATC (NPI 1437579109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437579109 NPI number — MR. DAVID YICK LEUNG WONG ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WONG
Provider First Name:
DAVID
Provider Middle Name:
YICK LEUNG
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUANG
Provider Other First Name:
I-LIANG
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1437579109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 CHANG AN EAST ROAD, SECTION 2
Provider Second Line Business Mailing Address:
4/FL.
Provider Business Mailing Address City Name:
TAIPEI
Provider Business Mailing Address State Name:
CHUNG SHAN PROVIDENCE
Provider Business Mailing Address Postal Code:
10455
Provider Business Mailing Address Country Code:
TW
Provider Business Mailing Address Telephone Number:
886935936635
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7822 DEER MEADOW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95823-4414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-421-4176
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2014

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: 2255A2300X , with the licence number:  000080272 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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