MEDICARE: MS. BETTY WONG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	50401	CA

General Provider Information

NPI Number	:	1639370729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BETTY WONG DDS

Provider Business Mailing Address
First Line	:	1196 SCOTT ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-4007
Country	:	US
Telephone Number	:	415-661-1893
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 CALIFORNIA ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1863
Country	:	US
Telephone Number	:	415-567-1532
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/08/2007

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