MEDICARE: DR. YINJIA GONG MD

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
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	0A56519	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588696637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YINJIA GONG MD

Provider Business Mailing Address
First Line	:	1520 BROOKHOLLOW DR STE 36
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-5427
Country	:	US
Telephone Number	:	714-881-7081
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 BROOKHOLLOW DR STE 36
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-5427
Country	:	US
Telephone Number	:	714-881-7081
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	02/24/2014

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Directions to “ DR. YINJIA GONG MD” Practice Location

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