Provider Demographics
NPI:1629099015
Name:NYONGO, OMONDI (MD)
Entity type:Individual
Prefix:DR
First Name:OMONDI
Middle Name:
Last Name:NYONGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 ALPINE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTOLA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94028-7521
Mailing Address - Country:US
Mailing Address - Phone:650-850-5323
Mailing Address - Fax:
Practice Address - Street 1:3130 ALPINE RD STE 200
Practice Address - Street 2:
Practice Address - City:PORTOLA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94028-7521
Practice Address - Country:US
Practice Address - Phone:650-850-5323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98323207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology