Individual
KALANE JADE WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1017 2ND ST, SANTA ROSA, CA 95404-6608
(707) 546-9800
(707) 546-4112
Mailing address
3536 MENDOCINO AVE, STE 200, SANTA ROSA, CA 95403-3634
(707) 546-9800
(707) 546-4112
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
G62085
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G620850
—
CA
01
—
P01035552
RAILROAD MEDICARE
—
Enumeration date
01/05/2006
Last updated
06/20/2012
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