MEDICARE: MS. LISA KAR YING WONG L. AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC 12665	CA

General Provider Information

NPI Number	:	1780821223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA KAR YING WONG L. AC.

Provider Business Mailing Address
First Line	:	PO BOX 10323
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95157-1323
Country	:	US
Telephone Number	:	408-337-2887
Fax Number	:	408-890-4689

Provider Business Practice Location Address
First Line	:	18988 COX AVE STE C
Second Line	:
City	:	SARATOGA
State	:	CA
Zip	:	95070-4154
Country	:	US
Telephone Number	:	408-337-2887
Fax Number	:	408-890-4689

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2009
Last Update Date	:	01/13/2011

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