Provider Demographics
NPI:1316393747
Name:PONG, TERRENCE (MD, PHD)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:
Last Name:PONG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DR.
Mailing Address - Street 2:FALK CARDIOVASCULAR RESEARCH BLDG.
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5407
Mailing Address - Country:US
Mailing Address - Phone:617-710-0918
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR.
Practice Address - Street 2:FALK CARDIOVASCULAR RESEARCH BLDG.
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5407
Practice Address - Country:US
Practice Address - Phone:617-710-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program