Provider Demographics
NPI:1972893279
Name:WONG, WAIYAN (LAC , LMT)
Entity type:Individual
Prefix:MS
First Name:WAIYAN
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:LAC , LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9909 IVALENES HOPE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4065
Mailing Address - Country:US
Mailing Address - Phone:512-761-1881
Mailing Address - Fax:
Practice Address - Street 1:12129 RANCH ROAD 620 N
Practice Address - Street 2:APT/SUITE
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1090
Practice Address - Country:US
Practice Address - Phone:512-761-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist