Healthcare Provider Details

I. General information

NPI: 1316393747
Provider Name (Legal Business Name): TERRENCE PONG M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W HUNTINGTON DR # A100
ARCADIA CA
91007-3050
US

IV. Provider business mailing address

125 W HUNTINGTON DR # A100
ARCADIA CA
91007-3050
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-5849
  • Fax: 323-865-5477
Mailing address:
  • Phone: 323-442-5849
  • Fax: 323-865-5477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberA154290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: