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General NPI Number Information
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NPI Number | 1184246696
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Entity Type | Organization
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Legal Business Name | PENINSULA WELLNESS CENTRE
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 05/07/2020
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Provider Practice Location Address
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Address Line | 2425 CALLIFORNIA ST STE E
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040
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Country | US
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Telephone | 650-961-2429
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Fax | 650-969-1107
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Provider Business Mailing Address
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Address Line | 2425 CALIFORNIA ST STE E
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-1462
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Country | US
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Telephone | 650-961-2429
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Fax | 650-969-1107
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHNNY VAN DUONG
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Credential | DC
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Telephone | 909-961-2429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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