Provider Demographics
NPI:1154772325
Name:GONG, SENA (MD)
Entity type:Individual
Prefix:
First Name:SENA
Middle Name:
Last Name:GONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 HOLLYWOOD BLVD APT 323
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-3268
Mailing Address - Country:US
Mailing Address - Phone:646-793-1489
Mailing Address - Fax:
Practice Address - Street 1:4850 HOLLYWOOD BLVD APT 323
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-3268
Practice Address - Country:US
Practice Address - Phone:646-793-1489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC193720207P00000X
NY301407207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine