MEDICARE: VANESSA W DONG

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	103K00000X	Behavior Analyst	1-19-38070	CA

General Provider Information

NPI Number	:	1467802876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA W DONG

Provider Business Mailing Address
First Line	:	6701 W 88TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3732
Country	:	US
Telephone Number	:	714-834-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	6701 W 88TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3732
Country	:	US
Telephone Number	:	714-834-1111
Fax Number	:

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

Provider Enumeration Date	:	06/16/2016
Last Update Date	:	02/14/2023

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