Provider Demographics
NPI:1891053153
Name:VONG, AMANDA TANG (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:TANG
Last Name:VONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:TANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17284 SLOVER AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-7584
Mailing Address - Country:US
Mailing Address - Phone:909-609-3200
Mailing Address - Fax:909-609-3203
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:LAKESIDE BUILDING SUITE 6223
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3887
Practice Address - Fax:216-844-1949
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA141034207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program