MEDICARE: CAROLYN 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	163W00000X	Registered Nurse	515183	CA

General Provider Information

NPI Number	:	1821929696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN WONG

Provider Business Mailing Address
First Line	:	93 VISTA MARIN DR
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-5229
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 MIRANDA AVE
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94304-1207
Country	:	US
Telephone Number	:	415-716-6810
Fax Number	:

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

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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Directions to “ CAROLYN WONG ” Practice Location

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