Provider Demographics
NPI:1164530614
Name:WONG-TAMBLYN, YUK FONG (MSW)
Entity Type:Individual
Prefix:
First Name:YUK
Middle Name:FONG
Last Name:WONG-TAMBLYN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ECHO
Other - Middle Name:
Other - Last Name:TAMBLYN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3450 GRANT PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608
Mailing Address - Country:US
Mailing Address - Phone:916-922-9868
Mailing Address - Fax:916-922-7342
Practice Address - Street 1:811 GRAND AVE STE D
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-3466
Practice Address - Country:US
Practice Address - Phone:916-922-9868
Practice Address - Fax:916-922-7342
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 25482104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker