Provider Demographics
NPI:1699092650
Name:UONG, DOMINIC CONG (LAC)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:CONG
Last Name:UONG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2687 BRADLEY LN
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-4595
Mailing Address - Country:US
Mailing Address - Phone:281-902-2315
Mailing Address - Fax:
Practice Address - Street 1:2013 WELLS BRANCH PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-6900
Practice Address - Country:US
Practice Address - Phone:512-835-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01193171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist