Healthcare Provider Details

I. General information

NPI: 1235603226
Provider Name (Legal Business Name): HONGDARA WONG DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7248 S LAND PARK DR STE 205
SACRAMENTO CA
95831-3661
US

IV. Provider business mailing address

1512 ENDRES CT
SACRAMENTO CA
95822-4233
US

V. Phone/Fax

Practice location:
  • Phone: 916-392-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number95008398
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number95008389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: