Provider Demographics
NPI:1275959074
Name:YIN-JIA GONG MEDICAL CORPORATION
Entity Type:Organization
Organization Name:YIN-JIA GONG MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YINJIA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:GONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-881-7081
Mailing Address - Street 1:1520 BROOKHOLLOW DR STE 36
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5427
Mailing Address - Country:US
Mailing Address - Phone:714-881-7081
Mailing Address - Fax:
Practice Address - Street 1:1520 BROOKHOLLOW DR STE 36
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5427
Practice Address - Country:US
Practice Address - Phone:714-881-7081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56519208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty