Active NPI
Cory Mason Gong
- Behavior Technician
- San Jose, CA
National Provider Identifier
1134744774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- Y4493272
- Practice address
- 1360 N Winchester Blvd Ste 5
San Jose, CA 95128-1150 - Phone
- (650) 380-6049
- NPI assigned
- Jun 9, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Y4493272 | CA | Primary |
Addresses
Primary practice location
1360 N Winchester Blvd Ste 5
San Jose, CA 95128-1150
Mailing address
1360 N Winchester Blvd Ste 5
San Jose, CA 95128-1150
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| Y4493272 | CA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591660800000",
"number": "1134744774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1360 N WINCHESTER BLVD STE 5",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951281150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1360 N WINCHESTER BLVD STE 5",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951281150",
"telephone_number": "650-380-6049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONG",
"first_name": "CORY",
"middle_name": "MASON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-09",
"last_updated": "2020-06-09",
"certification_date": "2020-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "Y4493272",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.