Healthcare Provider Details

I. General information

NPI: 1891849873
Provider Name (Legal Business Name): LYNNE MY-LINH WONG D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLENDE DENTAL GROUP 390 LAUREL ST, SUITE 310
SAN FRANCISCO CA
94118
US

IV. Provider business mailing address

1421 SILVER AVE
SAN FRANCISCO CA
94134-1227
US

V. Phone/Fax

Practice location:
  • Phone: 415-563-4261
  • Fax:
Mailing address:
  • Phone: 415-819-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: