Healthcare Provider Details

I. General information

NPI: 1124937990
Provider Name (Legal Business Name): STEPHANIE M. WONG, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 TELEGRAPH AVE
OAKLAND CA
94609-3606
US

IV. Provider business mailing address

2831 TELEGRAPH AVE
OAKLAND CA
94609-3606
US

V. Phone/Fax

Practice location:
  • Phone: 510-269-7469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHANIE WONG
Title or Position: PRESIDENT
Credential: MD
Phone: 510-269-7469