Healthcare Provider Details

I. General information

NPI: 1568476000
Provider Name (Legal Business Name): KAM YUEN WONG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 30TH ST SUITE 403
OAKLAND CA
94609-3305
US

IV. Provider business mailing address

400 30TH ST STE 403
OAKLAND CA
94609-3305
US

V. Phone/Fax

Practice location:
  • Phone: 510-839-5219
  • Fax: 510-832-7340
Mailing address:
  • Phone: 510-839-5219
  • Fax: 510-832-7340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE3387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: