Healthcare Provider Details

I. General information

NPI: 1811809437
Provider Name (Legal Business Name): MR. GUANGCHAO DONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22447 RUBY ST. APT 211
CASTRO VALLEY CA
94546
US

IV. Provider business mailing address

22447 RUBY ST. APT 211
CASTRO VALLEY CA
94546
US

V. Phone/Fax

Practice location:
  • Phone: 510-993-4295
  • Fax:
Mailing address:
  • Phone: 510-993-4295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number103125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: