Provider Demographics
NPI:1972993004
Name:DONG, GANGYI (OM)
Entity Type:Individual
Prefix:DR
First Name:GANGYI
Middle Name:
Last Name:DONG
Suffix:
Gender:M
Credentials:OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 MCDANIEL DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-6671
Mailing Address - Country:US
Mailing Address - Phone:610-430-6211
Mailing Address - Fax:610-896-7254
Practice Address - Street 1:1505 MCDANIEL DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-6671
Practice Address - Country:US
Practice Address - Phone:610-430-6211
Practice Address - Fax:610-896-7254
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000133171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist