Individual
DR. SAMUEL J WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2905 TELEGRAPH AVE, BERKELEY, CA 94705-2017
(510) 841-0411
(510) 204-9086
Mailing address
2905 TELEGRAPH AVE, BERKELEY, CA 94705-2017
(510) 841-4525
(510) 845-5030
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
20A5983
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX59830
—
CA
01
—
390004072
RAILROAD MEDICARE
CA
Enumeration date
09/17/2006
Last updated
03/05/2015
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