Provider Demographics
NPI:1528575552
Name:VONG, HONG SAY
Entity Type:Individual
Prefix:
First Name:HONG
Middle Name:SAY
Last Name:VONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 ARNOLD GAMBLE CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1707
Mailing Address - Country:US
Mailing Address - Phone:775-813-1763
Mailing Address - Fax:
Practice Address - Street 1:2419 DEL PASO BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-2508
Practice Address - Country:US
Practice Address - Phone:916-922-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist