=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912265463
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CECILIA WONG LEUNG L.AC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2012
-----------------------------------------------------
Last Update Date | 05/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1640 BUSH ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94109-5308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-271-6954
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501B ALVARADO ST
-----------------------------------------------------
City | BRISBANE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94005-1658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-271-6954
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 14700
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------