Healthcare Provider Details

I. General information

NPI: 1174036545
Provider Name (Legal Business Name): CHESTON WONG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 HAYES ST STE 302
SAN FRANCISCO CA
94117-1078
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 415-379-2900
  • Fax: 415-666-3144
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number58276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: