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General NPI Number Information
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NPI Number | 1083454672
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Entity Type | Individual
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Provider Name | ALLEN GONG MD
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Gender | Male
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Dates
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Enumeration Date | 05/30/2024
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 1 JARRETT WHITE RD
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City | TRIPLER AMC
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State | HI
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Zip | 96859-5001
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Country | US
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Telephone | 808-433-9728
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Fax |
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Provider Business Mailing Address
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Address Line | 1 JARRETT WHITE RD
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City | TRIPLER AMC
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State | HI
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Zip | 96859-5001
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Country | US
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Telephone | 808-433-9728
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number |
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License Number State | HI
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Taxonomy #2
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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 |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0101287237
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License Number State | VA
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