Provider Demographics
NPI:1396354304
Name:WONG, STEVEN G (MS, PHD, LAC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:WONG
Suffix:
Gender:M
Credentials:MS, PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3985 WONDERLAND HILL AVE # 100
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1038
Mailing Address - Country:US
Mailing Address - Phone:303-956-8543
Mailing Address - Fax:
Practice Address - Street 1:3985 WONDERLAND HILL AVE # 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1038
Practice Address - Country:US
Practice Address - Phone:303-956-8543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-26
Last Update Date:2020-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002546171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist