Provider Demographics
NPI:1982701355
Name:JONG, LAURA (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:JONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4000 PALOS VERDES DR N STE 104
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-2531
Mailing Address - Country:US
Mailing Address - Phone:310-373-7310
Mailing Address - Fax:310-373-7315
Practice Address - Street 1:4000 PALOS VERDES DR N STE 104
Practice Address - Street 2:SUITE 105
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-2531
Practice Address - Country:US
Practice Address - Phone:310-373-7310
Practice Address - Fax:310-373-7315
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-12-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG821242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology