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General NPI Number Information
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NPI Number | 1679375307
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Entity Type | Individual
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Provider Name | WESLEY GONG MD
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Gender | Male
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 01/25/2026
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Provider Practice Location Address
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Address Line | 1250 16TH ST
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City | SANTA MONICA
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State | CA
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Zip | 90404-1249
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Country | US
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Telephone | 310-319-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 782 HAWTHORNE DR
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City | FREMONT
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State | CA
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Zip | 94539-5758
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Country | US
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Telephone | 510-857-4726
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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 | 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 | CA
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