Healthcare Provider Details

I. General information

NPI: 1639438625
Provider Name (Legal Business Name): PENNY WONG L. AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 WASHINGTON AVE SUITE #240
WHITTIER CA
90602-1484
US

IV. Provider business mailing address

917 W DUARTE RD UNIT 4
ARCADIA CA
91007-7457
US

V. Phone/Fax

Practice location:
  • Phone: 818-701-1800
  • Fax: 818-885-1171
Mailing address:
  • Phone: 626-354-3651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number14653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: