Provider Demographics
NPI:1972145209
Name:GONG, ADINA
Entity type:Individual
Prefix:
First Name:ADINA
Middle Name:
Last Name:GONG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9332 LANDINGS LN UNIT 601
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-5247
Mailing Address - Country:US
Mailing Address - Phone:347-702-2888
Mailing Address - Fax:
Practice Address - Street 1:9332 LANDINGS LN UNIT 601
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-5247
Practice Address - Country:US
Practice Address - Phone:347-702-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010099224Z00000X
IL057.005748224Z00000X
NY028812225X00000X
IL056.015879225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant