Provider Demographics
NPI:1780661173
Name:POON, GWENETH (MD)
Entity Type:Individual
Prefix:DR
First Name:GWENETH
Middle Name:
Last Name:POON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:QUYEN
Other - Middle Name:HUE
Other - Last Name:GIANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2620 GRAZING POINT WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8182
Mailing Address - Country:US
Mailing Address - Phone:916-714-6543
Mailing Address - Fax:916-734-6548
Practice Address - Street 1:6600 BRUCEVILLE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-4671
Practice Address - Country:US
Practice Address - Phone:916-688-2000
Practice Address - Fax:916-734-6548
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA760542085R0204X, 2471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN