Basic Information
Provider Information
NPI: 1699756197
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ONG
FirstName: JUNE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4860 Y ST
Address2: SUITE 3850
City: SACRAMENTO
State: CA
PostalCode: 958172307
CountryCode: US
TelephoneNumber: 9167345292
FaxNumber: 9167347838
Practice Location
Address1: 4860 Y ST
Address2: SUITE 3850
City: SACRAMENTO
State: CA
PostalCode: 958172307
CountryCode: US
TelephoneNumber: 9167345292
FaxNumber: 9167347838
Other Information
ProviderEnumerationDate: 11/10/2005
LastUpdateDate: 12/13/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208100000XNACAY Allopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 

No ID Information.


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