Healthcare Provider Details

I. General information

NPI: 1841229317
Provider Name (Legal Business Name): ANDREA WONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 12/14/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3285 CLAREMONT WAY
NAPA CA
94558-3313
US

IV. Provider business mailing address

227 BUTTERCUP CT
NAPA CA
94559-3585
US

V. Phone/Fax

Practice location:
  • Phone: 707-258-2500
  • Fax:
Mailing address:
  • Phone: 707-251-9879
  • Fax: 707-251-9879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM0976
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA95605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: