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NPI Code Detail

MEDICARE: LAURA WONG

MEDICARE: LAURA 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
1171100000XAcupuncturist0121000697VA

General Provider Information

NPI Number : 1508257106
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA WONG
Provider Business Mailing Address
First Line : 524 SOUTHPARK BLVD
Second Line : JENCARE NEIGHBORHOOD MEDICAL SOUTH PARK, LLC
City : COLONIAL HEIGHTS
State : VA
Zip : 23834-3609
Country : US
Telephone Number : 804-504-7980
Fax Number : 804-504-7991
Provider Business Practice Location Address
First Line : 524 SOUTHPARK BLVD
Second Line : JENCARE NEIGHBORHOOD MEDICAL SOUTH PARK, LLC
City : COLONIAL HEIGHTS
State : VA
Zip : 23834-3609
Country : US
Telephone Number : 804-504-7980
Fax Number : 804-504-7991
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2015
Last Update Date : 02/18/2015

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Directions to “ LAURA WONG ” Practice Location

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