Basic Information
| Provider Information | |||||||||
| NPI: | 1801393160 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONG | ||||||||
| FirstName: | JOANNA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8414 NAAB RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462601972 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8414 NAAB RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462601972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173387510 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2018 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0101X | 01087567A | IN | N | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery | 207NS0135X | 01087567A | IN | N | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207N00000X | 01087567A | IN | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.