Basic Information
| Provider Information | |||||||||
| NPI: | 1427285014 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | UC SAN FRANCISCO M691 | ||||||||
| Address2: | 505 PARNASSUS, BOX 0110 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941430001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154766245 | ||||||||
| FaxNumber: | 4154764009 | ||||||||
| Practice Location | |||||||||
| Address1: | UC SAN FRANCISCO M691 | ||||||||
| Address2: | 505 PARNASSUS, BOX 0110 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941430001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154766245 | ||||||||
| FaxNumber: | 4154764009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2009 | ||||||||
| LastUpdateDate: | 06/22/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A108029 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.