Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 0A56519 | CA |
NPI | 1588696637 |
---|---|
Provider Name | Dr. Yinjia Gong |
First Address | Santa Ana, CA 92705-5427 |
Second Address | Santa Ana, CA 92705-5427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 24/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A565190 | (05) | CA |
G47683 | (02) | CA |