Provider Demographics
NPI:1033535729
Name:SAM, WINGYEE (DPT)
Entity Type:Individual
Prefix:
First Name:WINGYEE
Middle Name:
Last Name:SAM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:SAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:2450 E DEL MAR BLVD
Mailing Address - Street 2:UNIT 31
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4819
Mailing Address - Country:US
Mailing Address - Phone:626-278-0400
Mailing Address - Fax:
Practice Address - Street 1:2450 E DEL MAR BLVD
Practice Address - Street 2:UNIT 31
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4819
Practice Address - Country:US
Practice Address - Phone:626-278-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33712225100000X
2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics