Provider Demographics
NPI:1790049088
Name:WONG, GERALDINE (GERALDINE WONG)
Entity Type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:GERALDINE WONG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 LUNADO WAY
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-2854
Mailing Address - Country:US
Mailing Address - Phone:415-584-1127
Mailing Address - Fax:
Practice Address - Street 1:165 LUNADO WAY
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-2854
Practice Address - Country:US
Practice Address - Phone:415-584-1127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA496243163W00000X
CAAC 14881171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse