Provider Demographics
NPI:1740286376
Name:ONG, VIVIAN C (MD)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:C
Last Name:ONG
Suffix:
Gender:F
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:PO BOX 908
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336-0908
Mailing Address - Country:US
Mailing Address - Phone:606-723-5142
Mailing Address - Fax:606-723-3798
Practice Address - Street 1:223 RIVER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-1142
Practice Address - Country:US
Practice Address - Phone:606-723-5142
Practice Address - Fax:606-723-3798
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32891208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64328917Medicaid
KYH97981Medicare UPIN
KY0790102Medicare ID - Type Unspecified