Provider Demographics
NPI:1538693726
Name:DONG, BAC-AI (PHARM D)
Entity Type:Individual
Prefix:
First Name:BAC-AI
Middle Name:
Last Name:DONG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2691 MCLAUGHLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-2752
Mailing Address - Country:US
Mailing Address - Phone:408-310-0651
Mailing Address - Fax:
Practice Address - Street 1:2691 MCLAUGHLIN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-2752
Practice Address - Country:US
Practice Address - Phone:408-310-0651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH76384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist