Provider Demographics
NPI:1437220696
Name:GONG, YU (LAC)
Entity type:Individual
Prefix:
First Name:YU
Middle Name:
Last Name:GONG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:4363 SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4735
Mailing Address - Country:US
Mailing Address - Phone:510-791-1855
Mailing Address - Fax:510-791-1855
Practice Address - Street 1:43334 BRYANT ST
Practice Address - Street 2:SUITE 8
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-5812
Practice Address - Country:US
Practice Address - Phone:510-770-9389
Practice Address - Fax:510-770-9389
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7042171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist