Provider Demographics
NPI:1164847018
Name:DONG, EDWARD V (DAOM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:DONG
Suffix:V
Gender:M
Credentials:DAOM
Other - Prefix:DR
Other - First Name:ZIHUA
Other - Middle Name:
Other - Last Name:DONG
Other - Suffix:V
Other - Last Name Type:Professional Name
Other - Credentials:DAOM
Mailing Address - Street 1:10601 S DE ANZA BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-4451
Mailing Address - Country:US
Mailing Address - Phone:408-861-0838
Mailing Address - Fax:408-861-0838
Practice Address - Street 1:10601 S DE ANZA BLVD STE 105
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-4451
Practice Address - Country:US
Practice Address - Phone:408-861-0838
Practice Address - Fax:408-861-0838
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-02
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12801171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist