Provider Demographics
NPI:1760176812
Name:GONG, ZHUORAN (NP)
Entity type:Individual
Prefix:
First Name:ZHUORAN
Middle Name:
Last Name:GONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5731 LOMA AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-2453
Mailing Address - Country:US
Mailing Address - Phone:626-244-9278
Mailing Address - Fax:
Practice Address - Street 1:2707 E VALLEY BLVD STE 208
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-3197
Practice Address - Country:US
Practice Address - Phone:626-581-0486
Practice Address - Fax:626-581-0161
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025244363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner