Healthcare Provider Details

I. General information

NPI: 1760001945
Provider Name (Legal Business Name): JANELLE KARISSA WONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HARTLE CT
NAPA CA
94559-4078
US

IV. Provider business mailing address

205 PLUM LAKE CT
SELLERSBURG IN
47172-9077
US

V. Phone/Fax

Practice location:
  • Phone: 707-254-1775
  • Fax:
Mailing address:
  • Phone: 502-718-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD217882
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA199539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: