Gong, Derek Patrick

Gong, Derek Patrick is an individual health care provider with primary practice located at 16319 Third Street , Santa Rosa CA 95409. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Gong, Derek Patrick can be contacted via phone (707) 869-2849.

Contact Information

Primary practice address
16319 Third Street Santa Rosa CA 95409
Phone: (707) 869-2849
Fax: (707) 869-1477
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X A66344 California
Allopathic & Osteopathic Physicians / Pediatrics 208000000X A66344 California

Profile Details

NPI number 1184671513
LBN Legal business name Gong, Derek Patrick
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 30th, 2006
Last updated Nov 28th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184671513 NPPES
California MEDICAID 00A663440
California Other ZZZ73222Z
California MEDICAID FHC03887F

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