Provider Demographics
NPI:1447314158
Name:WONG, Y. YVONNE (DDS)
Entity type:Individual
Prefix:DR
First Name:Y.
Middle Name:YVONNE
Last Name:WONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:YANNHWA
Other - Middle Name:YVONNE
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:963 E HILLSDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2112
Mailing Address - Country:US
Mailing Address - Phone:650-377-0281
Mailing Address - Fax:
Practice Address - Street 1:963 E HILLSDALE BLVD
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-2112
Practice Address - Country:US
Practice Address - Phone:650-377-0281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA335331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry