Provider Demographics
NPI:1427218692
Name:STEPHANUS ONG MD INC
Entity Type:Organization
Organization Name:STEPHANUS ONG MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANUS
Authorized Official - Middle Name:H
Authorized Official - Last Name:ONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-672-3888
Mailing Address - Street 1:27830 BRADLEY RD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2201
Mailing Address - Country:US
Mailing Address - Phone:951-672-3888
Mailing Address - Fax:951-672-3758
Practice Address - Street 1:27830 BRADLEY RD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-2201
Practice Address - Country:US
Practice Address - Phone:951-672-3888
Practice Address - Fax:951-672-3758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34813207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A348133Medicare PIN