Individual
DR. AMINA YIXUAN GONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
579 NEWFIELD AVE, STAMFORD, CT 06905-3302
(203) 890-9300
(203) 890-9250
Mailing address
579 NEWFIELD AVE, STAMFORD, CT 06905-3302
(203) 890-9300
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
058587
NY
122300000X
Dentist
Primary
12540
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04803581
—
NY
Enumeration date
06/16/2015
Last updated
06/09/2020
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