Provider Demographics
NPI:1033244017
Name:WONG, YUEN YEE (ACUPUNTURIST)
Entity Type:Individual
Prefix:
First Name:YUEN
Middle Name:YEE
Last Name:WONG
Suffix:
Gender:F
Credentials:ACUPUNTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5526
Mailing Address - Country:US
Mailing Address - Phone:209-464-4192
Mailing Address - Fax:
Practice Address - Street 1:2613 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5526
Practice Address - Country:US
Practice Address - Phone:209-464-4192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC0011760171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0011760OtherACUPUNTURE LIC. NUMBER