Provider Demographics
NPI:1720214828
Name:WONG, ELISA KANANI (L AC)
Entity Type:Individual
Prefix:MS
First Name:ELISA
Middle Name:KANANI
Last Name:WONG
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1203 N FAIRVALE AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722
Mailing Address - Country:US
Mailing Address - Phone:626-290-7999
Mailing Address - Fax:
Practice Address - Street 1:923 S CATALINA AVE
Practice Address - Street 2:
Practice Address - City:PEDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277
Practice Address - Country:US
Practice Address - Phone:310-540-8333
Practice Address - Fax:310-540-8385
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12981171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist