Provider Demographics
NPI:1871651752
Name:GONG, GORDON GEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:GEE
Last Name:GONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 W FREMONT AVE
Mailing Address - Street 2:# K- 4
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2315
Mailing Address - Country:US
Mailing Address - Phone:408-736-7744
Mailing Address - Fax:408-736-0540
Practice Address - Street 1:877 W FREMONT AVE
Practice Address - Street 2:# K- 4
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2315
Practice Address - Country:US
Practice Address - Phone:408-736-7744
Practice Address - Fax:408-736-0540
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA388421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice