MEDICARE: MR. TONY K 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	175T00000X	Peer Specialist
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1679902530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TONY K WONG

Provider Business Mailing Address
First Line	:	1282 MARKET ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-4801
Country	:	US
Telephone Number	:	415-579-3021
Fax Number	:

Provider Business Practice Location Address
First Line	:	1282 MARKET ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-4801
Country	:	US
Telephone Number	:	415-579-3021
Fax Number	:

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

Provider Enumeration Date	:	11/01/2013
Last Update Date	:	06/06/2016

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