Healthcare Provider Details

I. General information

NPI: 1871631176
Provider Name (Legal Business Name): JENNY WONG, DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5233 GEARY BLVD
SAN FRANCISCO CA
94118-2817
US

IV. Provider business mailing address

5233 GEARY BLVD
SAN FRANCISCO CA
94118-2817
US

V. Phone/Fax

Practice location:
  • Phone: 415-751-7900
  • Fax: 415-751-7910
Mailing address:
  • Phone:
  • Fax: 415-751-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number29067
License Number StateCA

VIII. Authorized Official

Name: DR. JENNY WONG
Title or Position: DENTIST
Credential: DDS
Phone: 415-751-7900