Healthcare Provider Details

I. General information

NPI: 1265469027
Provider Name (Legal Business Name): ALBINO ONG M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 SHERMAN CIR
VAN NUYS CA
91405-3052
US

IV. Provider business mailing address

14500 SHERMAN CIR
VAN NUYS CA
91405-3052
US

V. Phone/Fax

Practice location:
  • Phone: 818-908-8644
  • Fax: 818-504-4690
Mailing address:
  • Phone: 818-908-8644
  • Fax: 818-504-4690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA44742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: