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1598375982 NPI number — KRISTINA LYNN WONG PHARMD

NPI Number: 1598375982
Health Care Provider/Practitioner: KRISTINA LYNN WONG PHARMD

Information about “1598375982” NPI (KRISTINA LYNN WONG PHARMD) exists in 1598375982 in HTML format HTML  |  1598375982 in plain Text format TXT  |  1598375982 in PDF (Portable Document Format) PDF  |  1598375982 in an XML format XML  formats.

NPI Number : 1598375982 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1598375982",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WONG",
    "FirstName": "KRISTINA",
    "MiddleName": "LYNN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHARMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3767 CLARINGTON AVE APT 224",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOS ANGELES",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90034-5849",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "714-261-5232",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1795 2ND ST # B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BERKELEY",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94710-1704",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "510-559-5276",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/31/2020",
    "LastUpdateDate": "12/30/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "82609",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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