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General NPI Number Information
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NPI Number | 1366212656
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Entity Type | Organization
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Legal Business Name | CHRISTOPHER B. WONG, DDS, DENTAL CORP
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 409 CAMBRIDGE AVE
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City | PALO ALTO
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State | CA
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Zip | 94306-1614
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Country | US
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Telephone | 650-326-6319
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Fax |
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Provider Business Mailing Address
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Address Line | 3631 BASSETT CT
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-5202
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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 | DENTIST
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Name | CHRISTOPHER WONG
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Credential | DDS
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Telephone | 916-995-4782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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