Provider Demographics
NPI:1912265463
Name:LEUNG, CECILIA WONG (LAC)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:WONG
Last Name:LEUNG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501B ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:BRISBANE
Mailing Address - State:CA
Mailing Address - Zip Code:94005-1658
Mailing Address - Country:US
Mailing Address - Phone:415-271-6954
Mailing Address - Fax:
Practice Address - Street 1:1640 BUSH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5308
Practice Address - Country:US
Practice Address - Phone:415-271-6954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist