Provider Demographics
NPI:1033125075
Name:ONG, TIMOTHY PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:ONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 MOORPARK AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2631
Mailing Address - Country:US
Mailing Address - Phone:408-885-5000
Mailing Address - Fax:408-885-3335
Practice Address - Street 1:2400 MOORPARK AVE
Practice Address - Street 2:VHC MOORPARK INTERNAL MEDICINE CLINIC
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2631
Practice Address - Country:US
Practice Address - Phone:408-885-5000
Practice Address - Fax:408-885-3335
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80475207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G804750Medicaid
CA00G804750Medicaid
CA00G804750Medicare ID - Type Unspecified