Provider Demographics
NPI:1265851182
Name:EDQUILANG, JOANNE KRISSY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:KRISSY
Last Name:EDQUILANG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:415-600-1817
Mailing Address - Fax:415-369-1369
Practice Address - Street 1:2351 CLAY ST STE 512
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1931
Practice Address - Country:US
Practice Address - Phone:415-600-1817
Practice Address - Fax:415-369-1369
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA141509208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA141509OtherSTATE MEDICAL LICENSE