Provider Demographics
NPI:1346882875
Name:GONG, HONGXU (LMT)
Entity Type:Individual
Prefix:
First Name:HONGXU
Middle Name:
Last Name:GONG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 W NOB HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3900
Mailing Address - Country:US
Mailing Address - Phone:509-972-4000
Mailing Address - Fax:509-972-4001
Practice Address - Street 1:4114 W NOB HILL BLVD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3900
Practice Address - Country:US
Practice Address - Phone:509-972-4000
Practice Address - Fax:509-972-4001
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61009703225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1588848626OtherEMPLOYER GROUP NPI