Provider Demographics
NPI:1407362528
Name:WONG, DAVID TAI WAI
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:TAI WAI
Last Name:WONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 WESSEX WAY APT 3
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-2736
Mailing Address - Country:US
Mailing Address - Phone:808-382-1329
Mailing Address - Fax:
Practice Address - Street 1:610 WESSEX WAY APT 3
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-2736
Practice Address - Country:US
Practice Address - Phone:808-382-1329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist