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1952669715 NPI number — JENNIFER VONG DO

NPI Number: 1952669715
Health Care Provider/Practitioner: JENNIFER VONG DO

Information about “1952669715” NPI (JENNIFER VONG DO) exists in 1952669715 in HTML format HTML  |  1952669715 in plain Text format TXT  |  1952669715 in PDF (Portable Document Format) PDF  |  1952669715 in an XML format XML  formats.

NPI Number : 1952669715 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1952669715",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VONG",
    "FirstName": "JENNIFER",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3660 ARLINGTON AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RIVERSIDE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92506-3912",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "21634 RETREAT PKWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CORONA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92883-6100",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "951-493-6935",
    "PracticeLocationAddressFaxNumber": "951-826-8134",
    "EnumerationDate": "04/30/2012",
    "LastUpdateDate": "07/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207V00000X",
          "TaxonomyName": "Obstetrics & Gynecology Physician",
          "LicenseNumber": "2016025642",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207V00000X",
          "TaxonomyName": "Obstetrics & Gynecology Physician",
          "LicenseNumber": "20A15528",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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