Healthcare Provider Details

I. General information

NPI: 1871651752
Provider Name (Legal Business Name): GORDON GEE GONG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 W. FREMONT AVE. #X
SUNNYVALE CA
94087
US

IV. Provider business mailing address

990 W. FREMONT AVE. #X #X
SUNNYVALE CA
94087
US

V. Phone/Fax

Practice location:
  • Phone: 408-736-7744
  • Fax: 408-736-0540
Mailing address:
  • Phone: 408-736-7744
  • Fax: 408-736-0540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number38842
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number38842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: