Provider Demographics
NPI:1932336815
Name:WONG, JESSICA MEI-WEN (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MEI-WEN
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 1:1351 24TH AVE
Mailing Address - Street 2:INTERNAL MEDICINE
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1616
Mailing Address - Country:US
Mailing Address - Phone:415-682-1900
Mailing Address - Fax:415-753-8134
Practice Address - Street 1:1351 24TH AVE
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1616
Practice Address - Country:US
Practice Address - Phone:415-682-1900
Practice Address - Fax:415-753-8134
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA127789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA002773702Medicare PIN