Provider Demographics
NPI:1639438625
Name:WONG, PENNY (L AC)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 W DUARTE RD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7457
Mailing Address - Country:US
Mailing Address - Phone:626-354-3651
Mailing Address - Fax:
Practice Address - Street 1:7007 WASHINGTON AVE
Practice Address - Street 2:SUITE #240
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1484
Practice Address - Country:US
Practice Address - Phone:818-701-1800
Practice Address - Fax:818-885-1171
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14653171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist