Provider Demographics
NPI:1740500313
Name:MA, MARC HUALONG (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:HUALONG
Last Name:MA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HUALONG
Other - Middle Name:
Other - Last Name:MA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1818 SIERRA LEONE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-3696
Mailing Address - Country:US
Mailing Address - Phone:626-536-7534
Mailing Address - Fax:
Practice Address - Street 1:1818 SIERRA LEONE AVE STE E
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-3696
Practice Address - Country:US
Practice Address - Phone:626-600-8066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10036754207Q00000X
CAA122326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine