Provider Demographics
NPI:1518000231
Name:ONG, JENNY (OD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:ONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:KIM-ONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2240 NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1068
Mailing Address - Country:US
Mailing Address - Phone:714-501-5300
Mailing Address - Fax:
Practice Address - Street 1:3873 PORTOLA PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-0828
Practice Address - Country:US
Practice Address - Phone:714-730-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10346T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU54207Medicare UPIN