MEDICARE: KATHY KA YEE WONG DDS

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	107582	CA

General Provider Information

NPI Number	:	1467076893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY KA YEE WONG DDS

Provider Business Mailing Address
First Line	:	2543 27TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-2909
Country	:	US
Telephone Number	:	415-994-9987
Fax Number	:

Provider Business Practice Location Address
First Line	:	2543 27TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-2909
Country	:	US
Telephone Number	:	415-994-9987
Fax Number	:

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

Provider Enumeration Date	:	06/01/2020
Last Update Date	:	01/05/2023

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