Healthcare Provider Details

I. General information

NPI: 1912058603
Provider Name (Legal Business Name): GAIL WONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 WEBSTER ST #509
OAKLAND CA
94609-3117
US

IV. Provider business mailing address

3300 WEBSTER ST #509
OAKLAND CA
94609-3117
US

V. Phone/Fax

Practice location:
  • Phone: 510-452-2833
  • Fax: 510-452-2152
Mailing address:
  • Phone: 510-452-2833
  • Fax: 510-452-2152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG032571
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberG032571
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: