Provider Demographics
NPI:1245333582
Name:WONG, SANDY H (OMD)
Entity type:Individual
Prefix:DR
First Name:SANDY
Middle Name:H
Last Name:WONG
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 FOREST AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4816
Mailing Address - Country:US
Mailing Address - Phone:408-688-6947
Mailing Address - Fax:408-369-8866
Practice Address - Street 1:2040 FOREST AVE. SUITE 8
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:94086-4816
Practice Address - Country:US
Practice Address - Phone:408-688-6947
Practice Address - Fax:408-369-8866
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA7393171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist