Provider Demographics
NPI:1376821405
Name:ONG, JOE ANDREWS (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:ANDREWS
Last Name:ONG
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:URNOS
Other - Last Name:ONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10833 LE CONTE AVE
Mailing Address - Street 2:64-128 CHS
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-3075
Mailing Address - Country:US
Mailing Address - Phone:310-794-7333
Mailing Address - Fax:310-794-7335
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:64-128 CHS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-794-7333
Practice Address - Fax:310-794-7335
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP20499363LA2100X
CACNS3570364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFC380ZMedicare PIN