Healthcare Provider Details

I. General information

NPI: 1144488974
Provider Name (Legal Business Name): DR. JENISE COLLEEN WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-6234
  • Fax: 415-353-2811
Mailing address:
  • Phone: 415-514-6234
  • Fax: 415-353-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberA108771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: