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General NPI Number Information
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NPI Number | 1578802450
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Entity Type | Organization
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Legal Business Name | WALTER RONG DDS, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/12/2013
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 236 W BADILLO ST
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City | COVINA
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State | CA
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Zip | 91723-1906
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Country | US
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Telephone | 626-339-7012
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Fax |
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Provider Business Mailing Address
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Address Line | 236 W BADILLO ST
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City | COVINA
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State | CA
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Zip | 91723-1906
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Country | US
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Telephone | 626-339-7012
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. WALTER RONG
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Credential | DDS
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Telephone | 626-339-7012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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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 | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 50094
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License Number State | CA
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