MEDICARE: DR. AUDREY Y ONG 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	174400000X	Specialist	A35615	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	A35615	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1033144365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUDREY Y ONG M.D.

Provider Business Mailing Address
First Line	:	1626 S BROADWAY
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92707-2214
Country	:	US
Telephone Number	:	714-541-2639
Fax Number	:	888-212-7464

Provider Business Practice Location Address
First Line	:	1626 S BROADWAY
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92707-2214
Country	:	US
Telephone Number	:	714-541-2639
Fax Number	:	888-212-7464

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/09/2007

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