Provider Demographics
NPI:1992038350
Name:BI, DONG (RPH)
Entity Type:Individual
Prefix:DR
First Name:DONG
Middle Name:
Last Name:BI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22432 HAWTHORN AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-6986
Mailing Address - Country:US
Mailing Address - Phone:951-750-0888
Mailing Address - Fax:
Practice Address - Street 1:22432 HAWTHORN AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-6986
Practice Address - Country:US
Practice Address - Phone:951-750-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 62152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist