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Contact Information

DEREK P GONG, MD
16319 THIRD STREET
SANTA ROSA, CA95409
 Phone: 707-869-2849
 Fax: 707-869-1477
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for DEREK P GONG · (Male)

NPI Number 1184671513
Status Active
Credentials MD
Entity Individual
Enumeration date 05/30/2006
Last updated 11/28/2007 - About 19 years ago
Sole proprietor 1 No
Identifiers
  • CA License # A66344
  • CA Medicaid 00A663440
  • CA Medicaid FHC03887F
  • CA Other ZZZ73222Z GROUP PTAN
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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