Active NPI
Kevin Wong
- Pharmacist
- Hercules, CA
National Provider Identifier
1275881237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 67355
- Practice address
- 2089 Pheasant Dr
Hercules, CA 94547-1627 - Phone
- (510) 799-2288
- NPI assigned
- Aug 23, 2012
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 67355 | CA | Primary |
Addresses
Primary practice location
2089 Pheasant Dr
Hercules, CA 94547-1627
Mailing address
999 Lake Dr
Issaquah, WA 98027-8990
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 |
|---|---|---|---|
| 67355 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1345680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446854400000",
"number": "1275881237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "999 LAKE DR",
"city": "ISSAQUAH",
"state": "WA",
"postal_code": "980278990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2089 PHEASANT DR",
"city": "HERCULES",
"state": "CA",
"postal_code": "945471627",
"telephone_number": "510-799-2288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "KEVIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-23",
"last_updated": "2015-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "67355",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hercules, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.