Provider Demographics
NPI:1740733385
Name:DONG, JASMINE B (RPH)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:B
Last Name:DONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 SEA CLIFF WAY
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-1043
Mailing Address - Country:US
Mailing Address - Phone:650-307-2755
Mailing Address - Fax:
Practice Address - Street 1:6007 CLARK RD
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4108
Practice Address - Country:US
Practice Address - Phone:530-872-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist