Basic Information
| Provider Information | |||||||||
| NPI: | 1194110700 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | RAN | ||||||||
| FirstName: | CONG | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7001 | ||||||||
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| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913577001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188887815 | ||||||||
| FaxNumber: | 8187151722 | ||||||||
| Practice Location | |||||||||
| Address1: | 1317 5TH ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904011433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104340044 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2015 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YS0123X | A167718 | CA | N | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207YX0007X | A167718 | CA | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Plastic Surgery within the Head & Neck |
No ID Information.