Provider Demographics
NPI:1336144088
Name:ONG, ANTONIO KAYABAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:KAYABAN
Last Name:ONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3505 HART AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2061
Mailing Address - Country:US
Mailing Address - Phone:626-573-1160
Mailing Address - Fax:626-573-1162
Practice Address - Street 1:3505 HART AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2061
Practice Address - Country:US
Practice Address - Phone:626-573-1160
Practice Address - Fax:626-573-1162
Is Sole Proprietor?:No
Enumeration Date:2005-06-18
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA36630208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36630OtherPRIVATE INSURANCE
CA00A366300Medicaid
CAA36630AMedicare ID - Type Unspecified
CA00A366300Medicaid