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General NPI Number Information
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NPI Number | 1205373644
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Entity Type | Individual
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Provider Name | CHELSEA ELIZABETH WONG D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 660 S BERNARDO AVE STE 1
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City | SUNNYVALE
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State | CA
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Zip | 94087-1066
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Country | US
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Telephone | 408-733-2008
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Fax |
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Provider Business Mailing Address
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Address Line | 235 CARBONERA AVE
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City | SUNNYVALE
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State | CA
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Zip | 94086-7005
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Country | US
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Telephone | 408-329-8521
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 059172
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 101920
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License Number State | CA
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