Healthcare Provider Details

I. General information

NPI: 1497475495
Provider Name (Legal Business Name): MS. TRACI DONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W STEWART DR
ORANGE CA
92868-3849
US

IV. Provider business mailing address

1010 W LA VETA AVE STE 360
ORANGE CA
92868-4303
US

V. Phone/Fax

Practice location:
  • Phone: 714-771-8000
  • Fax:
Mailing address:
  • Phone: 510-465-8986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPA62770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: