Provider Demographics
NPI:1881629251
Name:ONG, RICHARD Y (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:Y
Last Name:ONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-2214
Mailing Address - Country:US
Mailing Address - Phone:714-541-2639
Mailing Address - Fax:888-212-7464
Practice Address - Street 1:1626 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-2214
Practice Address - Country:US
Practice Address - Phone:714-541-2639
Practice Address - Fax:888-212-7464
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33718174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A337180Medicaid
CA00A337180Medicaid
CAA33718Medicare PIN