Provider Demographics
NPI:1730463415
Name:WONG, ALEXANDER HANS
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:HANS
Last Name:WONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-2514
Mailing Address - Country:US
Mailing Address - Phone:415-397-0837
Mailing Address - Fax:415-397-2936
Practice Address - Street 1:776 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-2514
Practice Address - Country:US
Practice Address - Phone:415-397-0837
Practice Address - Fax:415-397-2936
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist