Individual
JACQUELINE WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D., M.M.SC.
Contact information
Practice address
1998 BROADWAY, APT 1207, SAN FRANCISCO, CA 94109-2281
(415) 317-6430
(415) 346-8698
Mailing address
1998 BROADWAY, APT 1207, SAN FRANCISCO, CA 94109-2281
(415) 317-6430
(415) 346-8698
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
53490
CA
Other
Enumeration date
05/09/2007
Last updated
07/08/2007
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