Healthcare Provider Details

I. General information

NPI: 1588696637
Provider Name (Legal Business Name): YINJIA GONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YINJIA ROSE GONG MD

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 BROOKHOLLOW DR STE 36
SANTA ANA CA
92705-5427
US

IV. Provider business mailing address

1520 BROOKHOLLOW DR STE 36
SANTA ANA CA
92705-5427
US

V. Phone/Fax

Practice location:
  • Phone: 714-881-7081
  • Fax:
Mailing address:
  • Phone: 714-881-7081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number0A56519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: