MEDICARE: DR. MICHAEL GONG-RUEY HO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	A108864	CA

General Provider Information

NPI Number	:	1013171834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL GONG-RUEY HO M.D.

Provider Business Mailing Address
First Line	:	1801 WILSHIRE BLVD
Second Line	:	SUITE 100
City	:	SANTA MONICA
State	:	CA
Zip	:	01803
Country	:	US
Telephone Number	:	310-319-5098
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 WILSHIRE BLVD STE 100
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5609
Country	:	US
Telephone Number	:	310-319-5098
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	07/21/2022

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