Healthcare Provider Details

I. General information

NPI: 1942970397
Provider Name (Legal Business Name): KIANA TYLER WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HARBOR RD
SAN FRANCISCO CA
94124-2474
US

IV. Provider business mailing address

8945 GOLF LINKS RD
OAKLAND CA
94605-4124
US

V. Phone/Fax

Practice location:
  • Phone: 415-404-2602
  • Fax:
Mailing address:
  • Phone: 510-317-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: