Healthcare Provider Details

I. General information

NPI: 1568045508
Provider Name (Legal Business Name): JOHNSON ONG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11370 ANDERSON ST # 3650
LOMA LINDA CA
92354-3450
US

IV. Provider business mailing address

11234 ANDERSON ST # 1519
LOMA LINDA CA
92350-1716
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-2860
  • Fax:
Mailing address:
  • Phone: 909-558-4884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number20A22465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: