Provider Demographics
NPI:1780750588
Name:WONG, JONATHAN D (MD)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:D
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1520 STOCKTON ST
Mailing Address - Street 2:NORTH EAST MEDICAL SERVICES
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133
Mailing Address - Country:US
Mailing Address - Phone:415-391-9686
Mailing Address - Fax:415-433-4726
Practice Address - Street 1:1520 STOCKTON STREET
Practice Address - Street 2:NORTH EAST MEDICAL SERVICES
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133
Practice Address - Country:US
Practice Address - Phone:415-391-9686
Practice Address - Fax:415-433-4726
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA49948207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F98252Medicare UPIN