Active NPI
Vida Wong, PSY.D.
- Clinical Psychologist
- Pleasanton, CA
National Provider Identifier
1083783062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY30874
- Practice address
- 5674 Stoneridge Dr Ste 218
Pleasanton, CA 94588 - Phone
- (925) 307-6563
- NPI assigned
- Nov 6, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY30874 | CA | Primary |
Addresses
Primary practice location
5674 Stoneridge Dr Ste 218
Pleasanton, CA 94588
Mailing address
5674 Stoneridge Dr Ste 218
Pleasanton, CA 94588-8532
Phone (925) 307-6563
Other practice location 1
39210 State St Ste 109
Fremont, CA 94538-1456
Phone (510) 818-0892
Other practice location 2
310 8th St
Oakland, CA 94607-6526
Phone (510) 869-6043
Other practice location 3
39210 State St Ste 109
Fremont, CA 94538-1456
Phone (510) 818-0892
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY30874 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563408000000",
"number": "1083783062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5674 STONERIDGE DR STE 218",
"city": "PLEASANTON",
"state": "CA",
"postal_code": "945888532",
"telephone_number": "925-307-6563"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5674 STONERIDGE DR STE 218",
"city": "PLEASANTON",
"state": "CA",
"postal_code": "94588",
"telephone_number": "925-307-6563"
}
],
"practiceLocations": [
{
"address_1": "39210 State St Ste 109",
"address_purpose": "LOCATION",
"city": "Fremont",
"state": "CA",
"postal_code": "945381456",
"country_code": "US",
"telephone_number": "510-818-0892",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "310 8th St",
"address_purpose": "LOCATION",
"city": "Oakland",
"state": "CA",
"postal_code": "946076526",
"country_code": "US",
"telephone_number": "510-869-6043",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "39210 State St Ste 109",
"address_purpose": "LOCATION",
"city": "Fremont",
"state": "CA",
"postal_code": "945381456",
"country_code": "US",
"telephone_number": "510-818-0892",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WONG",
"first_name": "VIDA",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-06",
"last_updated": "2019-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY30874",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pleasanton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.