Healthcare Provider Details

I. General information

NPI: 1275814535
Provider Name (Legal Business Name): CHUNG-YUN CORRINE WANG N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MAIN ST SUITE A
LOS ALTOS CA
94022-2905
US

IV. Provider business mailing address

635 GEORGIA AVE
PALO ALTO CA
94306-3811
US

V. Phone/Fax

Practice location:
  • Phone: 650-352-3469
  • Fax:
Mailing address:
  • Phone: 650-799-0901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND-479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: