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NPI Code Detail

MEDICARE: JUNYANG GONG NP

MEDICARE: JUNYANG GONG NP
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
1390200000XStudent in an Organized Health Care Education/Training Program
2363L00000XNurse Practitioner019520OH

General Provider Information

NPI Number : 1801021183
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUNYANG GONG NP
Provider Business Mailing Address
First Line : 4081 DARBY RD
Second Line :
City : DAYTON
State : OH
Zip : 45431-1116
Country : US
Telephone Number : 646-706-2876
Fax Number :
Provider Business Practice Location Address
First Line : 2345 PHILADELPHIA DR
Second Line :
City : DAYTON
State : OH
Zip : 45406-1816
Country : US
Telephone Number : 937-276-4141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2009
Last Update Date : 11/15/2023

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