Provider Demographics
NPI:1538238977
Name:WONG, KWOK-LAP (LICACUPUNCTURIST)
Entity type:Individual
Prefix:MR
First Name:KWOK-LAP
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:LICACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 120454
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02112-0454
Mailing Address - Country:US
Mailing Address - Phone:617-542-2727
Mailing Address - Fax:617-542-2727
Practice Address - Street 1:65 HARRISON AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1924
Practice Address - Country:US
Practice Address - Phone:617-542-2727
Practice Address - Fax:617-542-2727
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist