Provider Demographics
NPI:1487985081
Name:WONG LEUNG, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:WONG LEUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 GILMAN CMN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2294
Mailing Address - Country:US
Mailing Address - Phone:510-440-1383
Mailing Address - Fax:
Practice Address - Street 1:3407 GILMAN CMN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2294
Practice Address - Country:US
Practice Address - Phone:510-440-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11048225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist