Provider Demographics
NPI:1023514338
Name:WONG, LISA KANATA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KANATA
Last Name:WONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF PATHOLOGY, 300 PASTEUR DRIVE
Mailing Address - Street 2:EDWARDS BUILDING, R204, MC: 5324
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94305-4245
Mailing Address - Country:US
Mailing Address - Phone:650-497-6374
Mailing Address - Fax:650-725-6902
Practice Address - Street 1:DEPARTMENT OF PATHOLOGY, 300 PASTEUR DRIVE
Practice Address - Street 2:EDWARDS BUILDING, R204, MC: 5324
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94305-4245
Practice Address - Country:US
Practice Address - Phone:650-497-6374
Practice Address - Fax:650-725-6902
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program