Healthcare Provider Details

I. General information

NPI: 1548470644
Provider Name (Legal Business Name): WING YEE WONG M.S., ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 TELEGRAPH AVE STE C
BERKELEY CA
94705-2072
US

IV. Provider business mailing address

3021 TELEGRAPH AVE STE C
BERKELEY CA
94705-2072
US

V. Phone/Fax

Practice location:
  • Phone: 510-900-9068
  • Fax: 510-835-0164
Mailing address:
  • Phone: 510-900-9068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number46725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: