Breane Wong, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA57180 Issued in CA

Practice address

1706 El Camino Real Ste 101
Menlo Park, CA 94027-4127

Phone

(650) 325-1395

NPI assigned

Sep 17, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588291200000",
    "number": "1659921039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 SHARON PARK DR APT 321",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940256911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1706 EL CAMINO REAL STE 101",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940274127",
            "telephone_number": "650-325-1395"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "675 Sharon Park Dr Apt 321",
            "address_purpose": "LOCATION",
            "city": "Menlo Park",
            "state": "CA",
            "postal_code": "940256911",
            "country_code": "US",
            "telephone_number": "530-304-2438",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WONG",
        "first_name": "BREANE",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-17",
        "last_updated": "2020-05-01",
        "certification_date": "2020-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA57180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "breane.wong@westernu.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "675 Sharon Park Dr Apt 321",
            "city": "Menlo Park",
            "state": "CA",
            "country_code": "US",
            "postal_code": "940256911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Shiva Wilson
• Mirene Winsberg, M.D.
• Ashley Witt, PH.D.
• Claire Wolf, LMFT
• Albert Wong, MD
• Daniel Wong, M.D.
• Hilton Wong
• Judy Wong, PH.D.
• Lorraine Wong, PHD
• Phillip Chung Kit Wong, MD

• Physician Assistant in Menlo Park, CA
• Providers in Menlo Park, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 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.

Verify at the official NPI Registry.