Provider Demographics
NPI:1083985899
Name:WONG, DANIEL HUGO (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:HUGO
Last Name:WONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1936
Mailing Address - Country:US
Mailing Address - Phone:408-732-3565
Mailing Address - Fax:
Practice Address - Street 1:150 E EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087
Practice Address - Country:US
Practice Address - Phone:408-732-3565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist