MEDICARE: DR. LYDIA WONG HUEY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	39728	CA

General Provider Information

NPI Number	:	1134296379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYDIA WONG HUEY D.D.S.

Provider Business Mailing Address
First Line	:	685 COMMERCIAL ST.
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94111-2503
Country	:	US
Telephone Number	:	415-421-0550
Fax Number	:	415-421-1097

Provider Business Practice Location Address
First Line	:	685 COMMERCIAL ST.
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94111-2503
Country	:	US
Telephone Number	:	415-421-0550
Fax Number	:	415-421-1097

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	06/06/2019

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