Healthcare Provider Details

I. General information

NPI: 1962278564
Provider Name (Legal Business Name): DANIEL WONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7521 E NORA AVE
SPOKANE VALLEY WA
99212-2516
US

IV. Provider business mailing address

1187 TURNBERRY DR
SPARKS NV
89436-1894
US

V. Phone/Fax

Practice location:
  • Phone: 808-444-1788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-59340
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: