Healthcare Provider Details

I. General information

NPI: 1376239947
Provider Name (Legal Business Name): SHELBY JEAN WONG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 E HERNDON AVE
FRESNO CA
93720-3303
US

IV. Provider business mailing address

PO BOX 889442
LOS ANGELES CA
90088-9442
US

V. Phone/Fax

Practice location:
  • Phone: 559-603-7240
  • Fax: 559-603-7261
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A23356
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: