Provider Demographics
NPI:1134211105
Name:WONG, CHRISTINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 YALE AVE # 200
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4340
Mailing Address - Country:US
Mailing Address - Phone:909-833-1596
Mailing Address - Fax:
Practice Address - Street 1:427 YALE AVE
Practice Address - Street 2:STE 200
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4340
Practice Address - Country:US
Practice Address - Phone:909-833-1596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21007103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY21007OtherLICENSE