Healthcare Provider Details

I. General information

NPI: 1790084077
Provider Name (Legal Business Name): MR. WESLEY WONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 EVANS AVE
SAN FRANCISCO CA
94124-1705
US

IV. Provider business mailing address

1305 EVANS AVE
SAN FRANCISCO CA
94124-1705
US

V. Phone/Fax

Practice location:
  • Phone: 415-920-7700
  • Fax: 415-920-7729
Mailing address:
  • Phone: 415-920-7700
  • Fax: 415-920-7729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: