Provider Demographics
NPI:1184754087
Name:WONG, WENDY (DDS)
Entity type:Individual
Prefix:
First Name:WENDY
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 1:2664 BERRYESSA RD STE 116
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2906
Mailing Address - Country:US
Mailing Address - Phone:408-263-6386
Mailing Address - Fax:408-957-7538
Practice Address - Street 1:2664 BERRYESSA RD STE 116
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2906
Practice Address - Country:US
Practice Address - Phone:408-263-6386
Practice Address - Fax:408-957-7538
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice