Healthcare Provider Details

I. General information

NPI: 1992864839
Provider Name (Legal Business Name): MARY WONG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 CLAY ST STE 537
SAN FRANCISCO CA
94115-1932
US

IV. Provider business mailing address

2340 CLAY ST STE 537
SAN FRANCISCO CA
94115-1932
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-1099
  • Fax: 415-600-1097
Mailing address:
  • Phone: 415-600-1099
  • Fax: 415-600-1097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNPF8766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: