Healthcare Provider Details

I. General information

NPI: 1083292569
Provider Name (Legal Business Name): STEPHANIE MAN-SEE WONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
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 Number187150
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number187150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: