Healthcare Provider Details

I. General information

NPI: 1659365286
Provider Name (Legal Business Name): GENE ONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 MOUNT MARIAH DR STE 150
LAS VEGAS NV
89106-1506
US

IV. Provider business mailing address

2545 S BRUCE ST STE 200
LAS VEGAS NV
89169-1778
US

V. Phone/Fax

Practice location:
  • Phone: 702-851-7766
  • Fax: 702-851-7760
Mailing address:
  • Phone: 702-732-2438
  • Fax: 702-737-5043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberL1150
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number12481
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: