Healthcare Provider Details

I. General information

NPI: 1598186181
Provider Name (Legal Business Name): KRISTIN WONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2013
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KAISER PLZ
OAKLAND CA
94612-3610
US

IV. Provider business mailing address

1 KAISER PLZ
OAKLAND CA
94612-3610
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-5913
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number11376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: