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NPI Code Detail

MEDICARE: WILLIAM C. GONG PHARM.D.

MEDICARE: WILLIAM C. GONG PHARM.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11835P1200XPharmacotherapy Pharmacist28923CA

General Provider Information

NPI Number : 1356364350
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM C. GONG PHARM.D.
Provider Business Mailing Address
First Line : 1301 VIA DEL REY
Second Line :
City : SOUTH PASADENA
State : CA
Zip : 91030-3630
Country : US
Telephone Number : 323-442-2648
Fax Number :
Provider Business Practice Location Address
First Line : 1985 ZONAL AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90089-5305
Country : US
Telephone Number : 323-442-2648
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 07/08/2007

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