Provider Demographics
NPI:1578727756
Name:WONG, MELISSA CHORYUN (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:CHORYUN
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1842 NORIEGA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-4324
Mailing Address - Country:US
Mailing Address - Phone:415-566-8799
Mailing Address - Fax:415-566-8785
Practice Address - Street 1:1842 NORIEGA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-4324
Practice Address - Country:US
Practice Address - Phone:415-566-8799
Practice Address - Fax:415-566-8785
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110373207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine