Provider Demographics
NPI:1346344629
Name:WONG, JENNIFER LEI KVAI YUNG (MSPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEI KVAI YUNG
Last Name:WONG
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7080 HOLLYWOOD BL
Mailing Address - Street 2:#815
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028
Mailing Address - Country:US
Mailing Address - Phone:323-957-9571
Mailing Address - Fax:323-957-9583
Practice Address - Street 1:7080 HOLLYWOOD BL
Practice Address - Street 2:#815
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028
Practice Address - Country:US
Practice Address - Phone:323-957-9571
Practice Address - Fax:323-957-9583
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT26655AMedicare UPIN
CAWPT26655AMedicare ID - Type Unspecified