MEDICARE: MELANIE MY WONG

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1316806433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE MY WONG

Provider Business Mailing Address
First Line	:	PO BOX 43
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91778-0043
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 E 12TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94606-2906
Country	:	US
Telephone Number	:	800-607-6377
Fax Number	:

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

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/16/2026

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Directions to “ MELANIE MY WONG ” Practice Location

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