Individual
CONG ZHOU SANTOSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
101 BODIN CIR, DAVID GRANT USAF MEDICAL CENTER, FAIRFIELD, CA 94535-1809
(707) 423-7342
Mailing address
60 MDG/SGOMI, 101 BODIN CIR, TRAVIS AFB, CA 94535
(707) 423-7342
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101257154
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/23/2013
Last updated
12/21/2021
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