Provider Demographics
NPI:1730243551
Name:WONG, YUMIKO (PA)
Entity type:Individual
Prefix:MISS
First Name:YUMIKO
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1310 SAN BERNARDINO RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4979
Mailing Address - Country:US
Mailing Address - Phone:909-941-0247
Mailing Address - Fax:909-948-7950
Practice Address - Street 1:1310 SAN BERNARDINO RD
Practice Address - Street 2:SUITE 105
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4979
Practice Address - Country:US
Practice Address - Phone:909-941-0247
Practice Address - Fax:909-948-7950
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18604363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant