Provider Demographics
NPI:1821403049
Name:RONG, JUAN
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:RONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 C ST STE 200E
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3363
Mailing Address - Country:US
Mailing Address - Phone:916-447-6267
Mailing Address - Fax:916-456-5842
Practice Address - Street 1:3301 C ST STE 200E
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3363
Practice Address - Country:US
Practice Address - Phone:916-447-6267
Practice Address - Fax:916-456-5842
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA144144207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program