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General NPI Number Information
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NPI Number | 1356174056
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Entity Type | Individual
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Provider Name | KING KI WONG RBT
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Gender | Female
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Dates
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Enumeration Date | 08/20/2024
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 3340 WALNUT AVE STE 290
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City | FREMONT
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State | CA
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Zip | 94538-2215
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Country | US
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Telephone | 510-968-2896
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Fax |
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Provider Business Mailing Address
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Address Line | 431 EL CAMINO REAL APT 5212
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City | SANTA CLARA
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State | CA
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Zip | 95050-7422
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Country | US
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Telephone | 408-464-9852
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-371119
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License Number State | CA
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