Healthcare Provider Details

I. General information

NPI: 1275090805
Provider Name (Legal Business Name): CHRISTOPHER CHOY WON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 N 1ST ST
DIXON CA
95620-2428
US

IV. Provider business mailing address

9609 ARELLANO CREEK CT
ELK GROVE CA
95624-4147
US

V. Phone/Fax

Practice location:
  • Phone: 707-678-4412
  • Fax:
Mailing address:
  • Phone: 510-304-3651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69037
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: