Healthcare Provider Details

I. General information

NPI: 1447251970
Provider Name (Legal Business Name): BONNIE GONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12910 TOTEM LAKE BLVD NE SUITE 102
KIRKLAND WA
98034-2954
US

IV. Provider business mailing address

12910 TOTEM LAKE BLVD NE SUITE 102
KIRKLAND WA
98034-2954
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-4455
  • Fax: 425-899-4434
Mailing address:
  • Phone: 425-899-4455
  • Fax: 425-899-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00037065
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: