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General NPI Number Information
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NPI Number | 1629104526
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Entity Type | Individual
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Provider Name | RIO SUTIKNO-ONG MD
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Gender | Male
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 420 W SAN BERNARDINO RD
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City | COVINA
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State | CA
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Zip | 91723
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Country | US
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Telephone | 626-915-6293
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Fax |
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Provider Business Mailing Address
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Address Line | 1438 E HOLT AVE
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City | COVINA
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State | CA
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Zip | 91724
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Country | US
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Telephone | 626-967-3213
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Fax | 626-918-3359
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | G42729
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License Number State | CA
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