Healthcare Provider Details

I. General information

NPI: 1801419502
Provider Name (Legal Business Name): KA MAN WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 ELLIS ST
SAN FRANCISCO CA
94115-4215
US

IV. Provider business mailing address

1355 ELLIS ST
SAN FRANCISCO CA
94115-4215
US

V. Phone/Fax

Practice location:
  • Phone: 415-567-2967
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number20522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: