Provider Demographics
NPI:1881689206
Name:ONG, BERNARD C (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:C
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 1:10300 W CHARLESTON BLVD
Mailing Address - Street 2:#13 141
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135
Mailing Address - Country:US
Mailing Address - Phone:702-796-7979
Mailing Address - Fax:702-456-7979
Practice Address - Street 1:8551 W LAKE MEAD BLVD
Practice Address - Street 2:SUITE 251
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-796-7979
Practice Address - Fax:702-456-7979
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2008-04-24
Deactivation Date:2005-10-26
Deactivation Code:
Reactivation Date:2007-12-31
Provider Licenses
StateLicense IDTaxonomies
NV10098207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018726Medicaid
NVP00289588OtherRR MEDICARE PROVIDER
NV36577Medicare ID - Type Unspecified
H64593Medicare UPIN
NVP00289588OtherRR MEDICARE PROVIDER