Active NPI
Mark Jeffrey Wong, D.C.
- Chiropractor
- Oakland, CA
National Provider Identifier
1720136724
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC25950
- Practice address
- 3540 Grand Ave
Oakland, CA 94610-2010 - Phone
- (510) 268-8557
- Fax
- (510) 268-8591
- NPI assigned
- Jan 8, 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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC25950 | CA | Primary |
Addresses
Primary practice location
3540 Grand Ave
Oakland, CA 94610-2010
Mailing address
3540 Grand Ave
Oakland, CA 94610-2010
Phone (510) 268-8557
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110816000155 | CA | Practitioner - Chiropractic | 4688843204 | Practice locations: Oakland, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Life Chiropractic College, 1997
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
3640 Grand Ave
Oakland, CA 94610-2023
Phone (510) 268-8557
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC25950 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720136724",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3540 GRAND AVE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946102010",
"telephone_number": "510-268-8557",
"fax_number": "510-268-8591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3540 GRAND AVE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946102010",
"telephone_number": "510-268-8557",
"fax_number": "510-268-8591"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "MARK",
"middle_name": "JEFFREY",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC25950",
"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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.