Provider Demographics
NPI:1003959180
Name:WONG, PAULINE FUE (LAC DC)
Entity Type:Individual
Prefix:MS
First Name:PAULINE
Middle Name:FUE
Last Name:WONG
Suffix:
Gender:F
Credentials:LAC DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 ASHBY AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:98705
Mailing Address - Country:US
Mailing Address - Phone:510-843-7878
Mailing Address - Fax:
Practice Address - Street 1:2615 ASHBY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:98705
Practice Address - Country:US
Practice Address - Phone:510-843-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12585111N00000X
CA3969171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist