Active NPI
Kimberly Wong
- Pharmacist
- San Francisco, CA
National Provider Identifier
1558874362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 77113
- Practice address
- 300 Gough St
San Francisco, CA 94102-5104 - Phone
- (415) 581-0600
- NPI assigned
- Nov 15, 2017
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 77113 | CA | Primary |
Addresses
Primary practice location
300 Gough St
San Francisco, CA 94102-5104
Mailing address
300 Gough St
San Francisco, CA 94102-5104
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 77113 | Other | CA | CALIFORNIA STATE BOARD OF PHARMACY |
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 |
|---|---|---|---|
| 77113 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- San Francisco, CA
- NPI 1134135791
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596758400000",
"number": "1558874362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 GOUGH ST",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941025104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 GOUGH ST",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941025104",
"telephone_number": "415-581-0600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "KIMBERLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-11-15",
"last_updated": "2020-08-07",
"certification_date": "2020-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "77113",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA STATE BOARD OF PHARMACY",
"identifier": "77113",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.