Provider Demographics
NPI:1306842331
Name:WONG, RYAN YEE (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:YEE
Last Name:WONG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-6144
Mailing Address - Country:US
Mailing Address - Phone:831-869-6016
Mailing Address - Fax:
Practice Address - Street 1:1299 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-6144
Practice Address - Country:US
Practice Address - Phone:831-869-6016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 29180OtherPPO
CADC0291801OtherPPIN
CADC0291800OtherBLUE SHIELD
CAZZZ03851ZMedicare ID - Type Unspecified
CADC0291801OtherPPIN