Healthcare Provider Details

I. General information

NPI: 1427458918
Provider Name (Legal Business Name): LETIE WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 08/18/2026
Certification Date:
Deactivation Date: 07/23/2015
Reactivation Date: 08/18/2026

III. Provider practice location address

5105 ISADOR LN
SACRAMENTO CA
95835-2063
US

IV. Provider business mailing address

5105 ISADOR LN
SACRAMENTO CA
95835-2063
US

V. Phone/Fax

Practice location:
  • Phone: 916-520-4549
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number54075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: