Provider Demographics
NPI:1881203198
Name:WONG, BRYAN KIRKLYN (DPT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:KIRKLYN
Last Name:WONG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 KAREN CT
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134-1952
Mailing Address - Country:US
Mailing Address - Phone:415-971-3082
Mailing Address - Fax:
Practice Address - Street 1:1085 W EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1030
Practice Address - Country:US
Practice Address - Phone:408-524-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic