Healthcare Provider Details

I. General information

NPI: 1184751612
Provider Name (Legal Business Name): DENISE LAI MING WONG PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 HICKEY BLVD
DALY CITY CA
94015-2770
US

IV. Provider business mailing address

395 HICKEY BLVD
DALY CITY CA
94015-2770
US

V. Phone/Fax

Practice location:
  • Phone: 650-758-5339
  • Fax:
Mailing address:
  • Phone: 650-758-5339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26762
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number59556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: