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General NPI Number Information
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NPI Number | 1487180964
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Entity Type | Individual
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Provider Name | PAUL H GONG MD
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Gender | Male
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 3999 DUTCHMANS LN STE 5D
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City | LOUISVILLE
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State | KY
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Zip | 40207-4744
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Country | US
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Telephone | 502-899-6782
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Fax | 502-540-7268
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5116
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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 |
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Taxonomy #2
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | 59299
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License Number State | KY
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