Provider Demographics
NPI:1275814535
Name:WANG, CHUNG-YUN CORRINE (ND)
Entity type:Individual
Prefix:
First Name:CHUNG-YUN
Middle Name:CORRINE
Last Name:WANG
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-3811
Mailing Address - Country:US
Mailing Address - Phone:650-799-0901
Mailing Address - Fax:
Practice Address - Street 1:160 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-2905
Practice Address - Country:US
Practice Address - Phone:650-352-3469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-479175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath