Individual
SHAN GONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
8413 N MILLBROOK AVE STE 101, FRESNO, CA 93720-2195
(559) 448-9000
Mailing address
8413 N MILLBROOK AVE STE 101, FRESNO, CA 93720-2195
(559) 448-9000
(559) 449-1142
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
101693
CA
1223X2210X
Orofacial Pain Dentistry
Primary
101693
CA
Other
Enumeration date
02/29/2016
Last updated
05/11/2026
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