Provider Demographics
NPI:1962723833
Name:WONG, STANLEY S (LAC)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:S
Last Name:WONG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 COLLIS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-1506
Mailing Address - Country:US
Mailing Address - Phone:626-864-8962
Mailing Address - Fax:
Practice Address - Street 1:4520 HUNTINGTON DR S
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-1913
Practice Address - Country:US
Practice Address - Phone:626-864-8962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13578171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist