Healthcare Provider Details

I. General information

NPI: 1003938341
Provider Name (Legal Business Name): ROY WONG DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 29TH STREET SUITE 200
OAKLAND CA
94609
US

IV. Provider business mailing address

401 29TH STREET SUITE 200
OAKLAND CA
94609
US

V. Phone/Fax

Practice location:
  • Phone: 510-444-7535
  • Fax: 510-444-7548
Mailing address:
  • Phone: 510-444-7535
  • Fax: 510-444-7548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17861
License Number StateCA

VIII. Authorized Official

Name: ROY WONG
Title or Position: DENTIST
Credential: DDS
Phone: 510-444-7535