Provider Demographics
NPI:1588625164
Name:WONG, JAMES HONG (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HONG
Last Name:WONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 BUCHANAN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3211
Mailing Address - Country:US
Mailing Address - Phone:415-931-1903
Mailing Address - Fax:415-931-1904
Practice Address - Street 1:1826 BUCHANAN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3211
Practice Address - Country:US
Practice Address - Phone:415-931-1903
Practice Address - Fax:415-931-1904
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7604TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD004300Medicaid
CASD0076040Medicaid
CAT10567Medicare UPIN
ZZZ246482Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CASD0076040Medicaid