Provider Demographics
NPI:1497521538
Name:GONG, XINYI (RD)
Entity Type:Individual
Prefix:
First Name:XINYI
Middle Name:
Last Name:GONG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ZOEY
Other - Middle Name:
Other - Last Name:GONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:331 SAINT NICHOLAS AVE # 1D
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2738
Mailing Address - Country:US
Mailing Address - Phone:626-297-9864
Mailing Address - Fax:
Practice Address - Street 1:331 SAINT NICHOLAS AVE # 1D
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2738
Practice Address - Country:US
Practice Address - Phone:626-297-9864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86089185133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered