1255321410 NPI number — BERNARD C ONG MD PC

Table of content: (NPI 1255321410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255321410 NPI number — BERNARD C ONG MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERNARD C ONG MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BERNARD ONG, MD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255321410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10300 W CHARLESTON BLVD
Provider Second Line Business Mailing Address:
#13-141
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89135-1037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-796-7979
Provider Business Mailing Address Fax Number:
702-456-7979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8551 W LAKE MEAD BLVD
Provider Second Line Business Practice Location Address:
SUITE 251
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-7642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-796-7979
Provider Business Practice Location Address Fax Number:
702-456-7979
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ONG
Authorized Official First Name:
BERNARD
Authorized Official Middle Name:
CHUA
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
702-796-7979

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  10098 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002018726 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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