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1508257106 NPI number — LAURA WONG

NPI Number: 1508257106
Health Care Provider/Practitioner: LAURA WONG

Information about “1508257106” NPI (LAURA WONG) exists in 1508257106 in HTML format HTML  |  1508257106 in plain Text format TXT  |  1508257106 in PDF (Portable Document Format) PDF  |  1508257106 in an XML format XML  formats.

NPI Number : 1508257106 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1508257106",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WONG",
    "FirstName": "LAURA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "524 SOUTHPARK BLVD",
    "SecondLineMailingAddress": "JENCARE NEIGHBORHOOD MEDICAL SOUTH PARK, LLC",
    "MailingAddressCityName": "COLONIAL HEIGHTS",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "23834-3609",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "804-504-7980",
    "MailingAddressFaxNumber": "804-504-7991",
    "FirstLinePracticeLocationAddress": "524 SOUTHPARK BLVD",
    "SecondLinePracticeLocationAddress": "JENCARE NEIGHBORHOOD MEDICAL SOUTH PARK, LLC",
    "PracticeLocationAddressCityName": "COLONIAL HEIGHTS",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23834-3609",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "804-504-7980",
    "PracticeLocationAddressFaxNumber": "804-504-7991",
    "EnumerationDate": "02/18/2015",
    "LastUpdateDate": "02/18/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "171100000X",
        "TaxonomyName": "Acupuncturist",
        "LicenseNumber": "0121000697",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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