Provider Demographics
NPI:1922781749
Name:DONG, GRANT
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:DONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BROADWAY APT 304
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-3660
Mailing Address - Country:US
Mailing Address - Phone:240-401-4350
Mailing Address - Fax:
Practice Address - Street 1:600 BROADWAY APT 304
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3660
Practice Address - Country:US
Practice Address - Phone:240-401-4350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program