Healthcare Provider Details

I. General information

NPI: 1407842149
Provider Name (Legal Business Name): HUNG V ONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 OLD NEWPORT BLVD # 200
NEWPORT BEACH CA
92663-4210
US

IV. Provider business mailing address

495 OLD NEWPORT BLVD # 200
NEWPORT BEACH CA
92663-4210
US

V. Phone/Fax

Practice location:
  • Phone: 949-646-7546
  • Fax: 949-646-7556
Mailing address:
  • Phone: 949-646-7546
  • Fax: 949-646-7556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG72989
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberG72989
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberG72989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: