Individual
ALICE GONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
350 HAWTHORNE AVE, RM 2346, OAKLAND, CA 94609-3108
(510) 869-6883
(510) 869-6888
Mailing address
325 DISTEL CIR, LOS ALTOS, CA 94022-1408
(510) 869-6883
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A133823
CA
208M00000X
Hospitalist Physician
Primary
A133823
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A133823
STATE LICENSE
CA
Enumeration date
02/24/2011
Last updated
02/18/2021
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