MEDICARE: DR. STANLEY KIN-SHING WONG 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	122300000X	Dentist	42964	CA

General Provider Information

NPI Number	:	1770617250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANLEY KIN-SHING WONG D.D.S.

Provider Business Mailing Address
First Line	:	2120 CARLMONT DR
Second Line	:	SUITE # 3
City	:	BELMONT
State	:	CA
Zip	:	94002-3488
Country	:	US
Telephone Number	:	650-592-6800
Fax Number	:	650-592-6865

Provider Business Practice Location Address
First Line	:	2120 CARLMONT DR
Second Line	:	SUITE # 3
City	:	BELMONT
State	:	CA
Zip	:	94002-3488
Country	:	US
Telephone Number	:	650-592-6800
Fax Number	:	650-592-6865

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. STANLEY KIN-SHING WONG D.D.S.” Practice Location

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