Most Relevant Information
Provider Data
| NPI Number: | 1003404633 |
| Provider Name: | IVAN WONG LMT |
| Entity Type: | Individual |
| Taxonomy Code: | 225700000X |
| Specialty: | Massage Therapist |
| License Number: | MST-000417 |
Most Important Dates
| Enumeration Date: | 01/08/2021 |
| Last Updated: | 01/08/2021 |
Provider Practice Location
2000 VIA DEL REY
SOUTH PASADENA
CA
910304146
Practice Location Phone/Fax
| Phone: | 3108666203 |
| Fax: |
Provider Mailing Location
2000 VIA DEL REY
SOUTH PASADENA
CA
910304146
Provider Mailing Phone/Fax
| Phone: | 3108666203 |
| Fax: |