Provider Demographics
NPI:1992281620
Name:WONG, LI SHAO
Entity type:Individual
Prefix:
First Name:LI
Middle Name:SHAO
Last Name:WONG
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 1:191 E EL CAMINO REAL SPC 130
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2714
Mailing Address - Country:US
Mailing Address - Phone:415-766-1628
Mailing Address - Fax:
Practice Address - Street 1:2034 FOREST AVE STE 1B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4809
Practice Address - Country:US
Practice Address - Phone:415-766-1628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18063171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist