Individual
JERRY WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3850 GRAND AVE, OAKLAND, CA 94610-1004
(888) 663-6331
(415) 252-7176
Mailing address
1 EMBARCADERO CTR STE 1900, SAN FRANCISCO, CA 94111-3723
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95244991
CA
363L00000X
Nurse Practitioner
Primary
95024472
CA
363LF0000X
Family Nurse Practitioner
95024472
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95244991
CALIFORNIA BOARD OF REGISTERED NURSING
CA
Enumeration date
05/28/2021
Last updated
03/04/2025
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