Provider Demographics
NPI:1144610122
Name:WONG, OI SHAN (NP)
Entity Type:Individual
Prefix:MR
First Name:OI SHAN
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 N WHITE RD STE 200B
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-1966
Mailing Address - Country:US
Mailing Address - Phone:408-503-7600
Mailing Address - Fax:408-503-7651
Practice Address - Street 1:255 N WHITE RD STE 200B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-1966
Practice Address - Country:US
Practice Address - Phone:408-503-7600
Practice Address - Fax:408-503-7651
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001919363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health