Provider Demographics
NPI:1487739025
Name:PON, GILBERT JEE (PT)
Entity type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:JEE
Last Name:PON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 W. GLENOAKS BLVD.
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1644
Mailing Address - Country:US
Mailing Address - Phone:818-846-3385
Mailing Address - Fax:818-848-4500
Practice Address - Street 1:1944 W. GLENOAKS BLVD.
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1644
Practice Address - Country:US
Practice Address - Phone:818-846-3385
Practice Address - Fax:818-848-4500
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 18539225100000X
CAPT18593B225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT18539BMedicare PIN