Provider Demographics
NPI:1518086610
Name:GONG, GUOJI (ACUPUNCTURIST,)
Entity Type:Individual
Prefix:
First Name:GUOJI
Middle Name:
Last Name:GONG
Suffix:
Gender:M
Credentials:ACUPUNCTURIST,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13010 N HIGHWAY 183
Mailing Address - Street 2:103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-3247
Mailing Address - Country:US
Mailing Address - Phone:512-219-0903
Mailing Address - Fax:
Practice Address - Street 1:13010 N HIGHWAY 183
Practice Address - Street 2:103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-3247
Practice Address - Country:US
Practice Address - Phone:512-219-0903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00051171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist