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General NPI Number Information
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NPI Number | 1518276310
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Entity Type | Organization
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Legal Business Name | ANTONIO K ONG MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/28/2010
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 3505 HART AVE SUITE 202
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City | ROSEMEAD
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State | CA
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Zip | 91770-2061
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Country | US
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Telephone | 626-573-1160
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Fax | 626-573-1162
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Provider Business Mailing Address
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Address Line | 3505 HART AVE SUITE 202
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City | ROSEMEAD
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State | CA
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Zip | 91770-2061
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Country | US
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Telephone | 626-573-1160
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Fax | 626-573-1162
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANTONIO KAYABAN ONG
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Credential | M.D.
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Telephone | 626-573-1160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A36630
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License Number State | CA
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