Provider Demographics
NPI:1366295057
Name:WONG, KIMBERLY LESLIE (FNP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LESLIE
Last Name:WONG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 MARKET ST APT 613
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1327
Mailing Address - Country:US
Mailing Address - Phone:408-568-5173
Mailing Address - Fax:
Practice Address - Street 1:1699 MARKET ST APT 613
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1327
Practice Address - Country:US
Practice Address - Phone:408-568-5173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025564363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily