Provider Demographics
NPI:1336155258
Name:DONG, DAVID K (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
Last Name:DONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:264 HIGHLAND SPRINGS AVE
Mailing Address - Street 2:BUILDING 1A
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-3045
Mailing Address - Country:US
Mailing Address - Phone:951-769-7191
Mailing Address - Fax:951-269-2167
Practice Address - Street 1:12980 FREDERICK ST STE I
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5263
Practice Address - Country:US
Practice Address - Phone:951-684-8020
Practice Address - Fax:951-684-8090
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2019-04-15
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Provider Licenses
StateLicense IDTaxonomies
CAA92705208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A927050Medicaid