Healthcare Provider Details

I. General information

NPI: 1225766967
Provider Name (Legal Business Name): JENNIFER WONG, O.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 SUTTER ST
SAN FRANCISCO CA
94104-4001
US

IV. Provider business mailing address

176 SUTTER ST
SAN FRANCISCO CA
94104-4001
US

V. Phone/Fax

Practice location:
  • Phone: 415-495-2020
  • Fax: 415-495-6095
Mailing address:
  • Phone: 415-495-2020
  • Fax: 415-495-6095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER WONG
Title or Position: PRESIDENT
Credential: OD
Phone: 713-898-1084