MEDICARE: DANNY WONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OTH-008266	AZ

General Provider Information

NPI Number	:	1427641414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANNY WONG

Provider Business Mailing Address
First Line	:	19430 S 210TH WAY
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-1625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 N SAN BENITO DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-2490
Country	:	US
Telephone Number	:	480-628-4180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2021
Last Update Date	:	02/19/2021

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Directions to “ DANNY WONG ” Practice Location

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