Provider Demographics
NPI:1013094127
Name:WONG, ROBIN CHUNG BOR (RPT)
Entity Type:Individual
Prefix:MR
First Name:ROBIN
Middle Name:CHUNG BOR
Last Name:WONG
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 JACKSON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133
Mailing Address - Country:US
Mailing Address - Phone:415-421-5678
Mailing Address - Fax:415-421-8231
Practice Address - Street 1:818 JACKSON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133
Practice Address - Country:US
Practice Address - Phone:415-421-5678
Practice Address - Fax:415-421-8231
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9507225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0095071Medicaid
00PT95071Medicare ID - Type Unspecified