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General NPI Number Information
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NPI Number | 1073143566
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Entity Type | Individual
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Provider Name | JENNY WONG MS ED
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Gender | Female
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Dates
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Enumeration Date | 01/23/2020
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 38 ACCACIA ST
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City | DALY CITY
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State | CA
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Zip | 94014-1503
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Country | US
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Telephone | 415-517-4721
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Fax |
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Provider Business Mailing Address
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Address Line | 38 ACCACIA ST
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City | DALY CITY
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State | CA
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Zip | 94014-1503
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1379600201
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License Number State | NY
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