Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | G72989 | CA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | G72989 | CA |
N | 207NS0135X | Procedural Dermatology | G72989 | CA |
NPI | 1407842149 |
---|---|
Provider Name | Dr. Hung V Ong |
First Address | Newport Beach, CA 92663-4210 |
Second Address | Newport Beach, CA 92663-4210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 07/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G15035 | (02) |