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General NPI Number Information
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NPI Number | 1033913223
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Entity Type | Individual
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Provider Name | ERIC BRANDON PONG MD
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Gender | Male
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 1101 MADISON ST
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City | SEATTLE
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State | WA
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Zip | 98104-1306
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Country | US
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Telephone | 253-363-7493
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Fax |
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Provider Business Mailing Address
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Address Line | 168 FLORENTIA ST APT 7
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City | SEATTLE
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State | WA
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Zip | 98109-1756
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Country | US
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Telephone | 253-363-7493
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MDRE.ML.61684539
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License Number State | WA
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