Provider Demographics
NPI:1316158751
Name:WONG, RALAN DAI MING
Entity type:Individual
Prefix:DR
First Name:RALAN
Middle Name:DAI MING
Last Name:WONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SPRUCE ST
Mailing Address - Street 2:STE #204
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2666
Mailing Address - Country:US
Mailing Address - Phone:415-221-1788
Mailing Address - Fax:
Practice Address - Street 1:500 SPRUCE ST
Practice Address - Street 2:STE #204
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2666
Practice Address - Country:US
Practice Address - Phone:415-221-1788
Practice Address - Fax:415-221-8361
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405131223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics