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General NPI Number Information
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NPI Number | 1508257106
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Entity Type | Individual
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Provider Name | LAURA WONG
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Gender | Female
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Dates
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Enumeration Date | 02/18/2015
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Last Update Date | 02/18/2015
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Provider Practice Location Address
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Address Line | 524 SOUTHPARK BLVD JENCARE NEIGHBORHOOD MEDICAL SOUTH PARK, LLC
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-3609
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Country | US
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Telephone | 804-504-7980
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Fax | 804-504-7991
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Provider Business Mailing Address
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Address Line | 524 SOUTHPARK BLVD JENCARE NEIGHBORHOOD MEDICAL SOUTH PARK, LLC
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-3609
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Country | US
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Telephone | 804-504-7980
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Fax | 804-504-7991
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 0121000697
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License Number State | VA
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