Provider Demographics
NPI:1932258258
Name:WONG, ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
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 1:5800 HOLLIS ST
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2016
Mailing Address - Country:US
Mailing Address - Phone:510-806-2100
Mailing Address - Fax:510-806-2557
Practice Address - Street 1:5800 HOLLIS ST
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2016
Practice Address - Country:US
Practice Address - Phone:510-806-2100
Practice Address - Fax:510-806-2557
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2017-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85039207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A850390Medicaid
I32816Medicare UPIN