Provider Demographics
NPI:1396297420
Name:CAI, GONG YIE
Entity type:Individual
Prefix:DR
First Name:GONG YIE
Middle Name:
Last Name:CAI
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 1:3663 SOLANO AVE
Mailing Address - Street 2:APT 13
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2767
Mailing Address - Country:US
Mailing Address - Phone:626-217-7348
Mailing Address - Fax:
Practice Address - Street 1:4300 SONOMA BLVD
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2200
Practice Address - Country:US
Practice Address - Phone:707-642-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist