Provider Demographics
NPI:1891849873
Name:WONG, LYNNE MY-LINH (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:MY-LINH
Last Name:WONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 SILVER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134-1227
Mailing Address - Country:US
Mailing Address - Phone:415-819-2566
Mailing Address - Fax:
Practice Address - Street 1:BLENDE DENTAL GROUP
Practice Address - Street 2:390 LAUREL ST, SUITE 310
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118
Practice Address - Country:US
Practice Address - Phone:415-563-4261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice