Healthcare Provider Details

I. General information

NPI: 1043233158
Provider Name (Legal Business Name): GREGORY TIMOTHY WONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 7TH ST
SAN FRANCISCO CA
94103-4003
US

IV. Provider business mailing address

229 7TH ST
SAN FRANCISCO CA
94103-4003
US

V. Phone/Fax

Practice location:
  • Phone: 415-503-6000
  • Fax: 415-503-6099
Mailing address:
  • Phone: 415-503-6000
  • Fax: 415-503-6099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301070265
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA69611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: