Healthcare Provider Details

I. General information

NPI: 1790810596
Provider Name (Legal Business Name): MATT SUN WONG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 W EL CAMINO REAL SUITE 4
MOUNTAIN VIEW CA
94040-1632
US

IV. Provider business mailing address

2290 W EL CAMINO REAL SUITE 4
MOUNTAIN VIEW CA
94040-1632
US

V. Phone/Fax

Practice location:
  • Phone: 650-965-2225
  • Fax: 650-967-5328
Mailing address:
  • Phone: 650-965-2225
  • Fax: 650-967-5328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number23709
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: