Active NPI
Sam Y Wong, D.D.S.
- Dentist
- Oakland, CA
National Provider Identifier
1003023268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 24696
- Practice address
- 1904 Franklin St
Suite 511
Oakland, CA 94612-2912 - Phone
- (510) 893-8066
- Fax
- (510) 893-6542
- NPI assigned
- May 17, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 24696 | CA | Primary |
Addresses
Primary practice location
1904 Franklin St
Suite 511
Oakland, CA 94612-2912
Mailing address
1904 Franklin St
Suite 511
Oakland, CA 94612-2912
Phone (510) 893-8066
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130610000226 | CA | Order and Referring Only - Oral Surgery | 9032358734 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003023268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1904 FRANKLIN ST",
"address_2": "SUITE 511",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946122912",
"telephone_number": "510-893-8066",
"fax_number": "510-893-6542"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1904 FRANKLIN ST",
"address_2": "SUITE 511",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946122912",
"telephone_number": "510-893-8066",
"fax_number": "510-893-6542"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "SAM",
"middle_name": "Y",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "24696",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.