Provider Demographics
NPI:1568474468
Name:WONG, YVONNE (DDS)
Entity type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 W EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1156
Mailing Address - Country:US
Mailing Address - Phone:408-245-6888
Mailing Address - Fax:
Practice Address - Street 1:903 W EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1156
Practice Address - Country:US
Practice Address - Phone:408-245-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA486971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB48697-01OtherHEALTHY FAMILIES
CAG92647-01Medicaid
CA30-0121327OtherTAX ID