Healthcare Provider Details

I. General information

NPI: 1366864126
Provider Name (Legal Business Name): MONT STONG AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SUTTER ST RM 934
SAN FRANCISCO CA
94115-3997
US

IV. Provider business mailing address

80 COLLINGWOOD ST APT 201
SAN FRANCISCO CA
94114-1997
US

V. Phone/Fax

Practice location:
  • Phone: 415-362-2901
  • Fax: 415-362-2429
Mailing address:
  • Phone: 415-404-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberDAU1201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: