Provider Demographics
NPI:1013325778
Name:DONG, DAVE SI
Entity Type:Individual
Prefix:MR
First Name:DAVE
Middle Name:SI
Last Name:DONG
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DAVE
Other - Middle Name:SI
Other - Last Name:DONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5454 CROSSINGS DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677
Mailing Address - Country:US
Mailing Address - Phone:916-783-8052
Mailing Address - Fax:916-783-8066
Practice Address - Street 1:5609 PACIFIC STREET
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677
Practice Address - Country:US
Practice Address - Phone:916-783-8052
Practice Address - Fax:916-783-8066
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist