Healthcare Provider Details

I. General information

NPI: 1104369198
Provider Name (Legal Business Name): STEPHANIE DONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 N CALIFORNIA ST STE 201
STOCKTON CA
95204-6032
US

IV. Provider business mailing address

1805 N CALIFORNIA ST STE 201
STOCKTON CA
95204-6032
US

V. Phone/Fax

Practice location:
  • Phone: 209-645-4005
  • Fax:
Mailing address:
  • Phone: 209-645-4005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA148032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: