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General NPI Number Information
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NPI Number | 1760176812
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Entity Type | Individual
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Provider Name | ZHUORAN GONG NP
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Gender | Female
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Dates
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Enumeration Date | 06/02/2023
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 2707 E VALLEY BLVD STE 208
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City | WEST COVINA
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State | CA
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Zip | 91792-3197
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Country | US
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Telephone | 626-581-0486
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Fax | 626-581-0161
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Provider Business Mailing Address
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Address Line | 5731 LOMA AVE
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City | TEMPLE CITY
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State | CA
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Zip | 91780-2453
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Country | US
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Telephone | 626-244-9278
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95025244
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License Number State | CA
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