Provider Demographics
NPI:1902138787
Name:WONG, GORDON K
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:K
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 1:1038 POST ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5603
Mailing Address - Country:US
Mailing Address - Phone:415-775-2636
Mailing Address - Fax:415-775-1345
Practice Address - Street 1:1038 POST ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5603
Practice Address - Country:US
Practice Address - Phone:415-775-2636
Practice Address - Fax:415-775-1345
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker