Healthcare Provider Details

I. General information

NPI: 1073257952
Provider Name (Legal Business Name): STEPHANIE YUEN TING WONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL DR STE 4A
MOUNTAIN VIEW CA
94040-4110
US

IV. Provider business mailing address

2500 HOSPITAL DR STE 4A
MOUNTAIN VIEW CA
94040-4110
US

V. Phone/Fax

Practice location:
  • Phone: 650-940-1006
  • Fax:
Mailing address:
  • Phone: 650-940-1006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA208891
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4351049275
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: