Healthcare Provider Details

I. General information

NPI: 1578427936
Provider Name (Legal Business Name): KEZIAH JAMES WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 CHENERY ST STE C
SAN FRANCISCO CA
94131-3097
US

IV. Provider business mailing address

605 CHENERY ST STE C
SAN FRANCISCO CA
94131-3097
US

V. Phone/Fax

Practice location:
  • Phone: 415-585-1990
  • Fax:
Mailing address:
  • Phone: 415-585-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: