Healthcare Provider Details

I. General information

NPI: 1649930082
Provider Name (Legal Business Name): JACQUELINE ONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5349 COLLEGE AVE
OAKLAND CA
94618-1416
US

IV. Provider business mailing address

4096 PIEDMONT AVE STE 508
OAKLAND CA
94611-5221
US

V. Phone/Fax

Practice location:
  • Phone: 510-658-0275
  • Fax:
Mailing address:
  • Phone: 510-658-0275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number86543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: