Provider Demographics
NPI:1689837742
Name:WONG, JENNY (MD)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 PROSPECT PL STE 340B
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1991
Mailing Address - Country:US
Mailing Address - Phone:619-522-4000
Mailing Address - Fax:619-435-0150
Practice Address - Street 1:230 PROSPECT PL STE 340B
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1991
Practice Address - Country:US
Practice Address - Phone:619-522-4000
Practice Address - Fax:619-435-0150
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96793207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine