Provider Demographics
NPI:1205373644
Name:WONG, CHELSEA ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:ELIZABETH
Last Name:WONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 CARBONERA AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-7005
Mailing Address - Country:US
Mailing Address - Phone:408-329-8521
Mailing Address - Fax:
Practice Address - Street 1:660 S BERNARDO AVE STE 1
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1066
Practice Address - Country:US
Practice Address - Phone:408-733-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0591721223P0221X
CA1019201223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry