Provider Demographics
NPI:1073804779
Name:VONG, SHEUNG KAI
Entity Type:Individual
Prefix:
First Name:SHEUNG
Middle Name:KAI
Last Name:VONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10418 VALLEY BLVD
Mailing Address - Street 2:STE. B
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-3600
Mailing Address - Country:US
Mailing Address - Phone:626-453-8466
Mailing Address - Fax:626-453-8456
Practice Address - Street 1:10418 VALLEY BLVD
Practice Address - Street 2:STE B
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3600
Practice Address - Country:US
Practice Address - Phone:626-453-8466
Practice Address - Fax:626-453-8456
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine