Healthcare Provider Details

I. General information

NPI: 1851911242
Provider Name (Legal Business Name): DANIEL KENNETH WONG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2020
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 SAND CREEK RD
ANTIOCH CA
94531-8687
US

IV. Provider business mailing address

7700 W SHORE DR
SACRAMENTO CA
95831-4379
US

V. Phone/Fax

Practice location:
  • Phone: 925-813-6500
  • Fax:
Mailing address:
  • Phone: 916-384-8140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number86944
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: