Healthcare Provider Details

I. General information

NPI: 1881815249
Provider Name (Legal Business Name): CATHY JANE WONG D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17161 GOLDENWEST ST STE H
HUNTINGTON BEACH CA
92647-5480
US

IV. Provider business mailing address

17161 GOLDENWEST ST STE H
HUNTINGTON BEACH CA
92647-5480
US

V. Phone/Fax

Practice location:
  • Phone: 714-847-4995
  • Fax: 714-847-7110
Mailing address:
  • Phone: 714-847-4995
  • Fax: 714-847-7110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number21610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: