Provider Demographics
NPI:1427292705
Name:ONG, DANIEL STEVEN GAN
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:STEVEN GAN
Last Name:ONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 HERITAGE PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-8727
Mailing Address - Country:US
Mailing Address - Phone:469-800-3200
Mailing Address - Fax:469-800-3210
Practice Address - Street 1:5308 N GALLOWAY AVE STE 201
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-1125
Practice Address - Country:US
Practice Address - Phone:469-800-3200
Practice Address - Fax:469-800-3210
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA136083207R00000X
TXR2192207RC0000X, 207RI0011X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program