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General NPI Number Information
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NPI Number | 1437579109
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Entity Type | Individual
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Provider Name | DAVID YICK LEUNG WONG ATC
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Gender | Male
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 7822 DEER MEADOW DR
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City | SACRAMENTO
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State | CA
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Zip | 95823-4414
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Country | US
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Telephone | 916-421-4176
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Fax |
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Provider Business Mailing Address
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Address Line | 65 CHANG AN EAST ROAD, SECTION 2 4/FL.
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City | TAIPEI
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State | CHUNG SHAN PROVIDENCE
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Zip | 10455
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Country | TW
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Telephone | 886935936635
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 000080272
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License Number State | CA
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