Active NPI
Justin Gong
- Pharmacist
- Fairfield, CA
National Provider Identifier
1447717566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 77646
- Practice address
- 2059 Cadenasso Dr
Fairfield, CA 94533-6806 - Phone
- (707) 759-0005
- NPI assigned
- Feb 25, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 77646 | CA | Primary |
Addresses
Primary practice location
2059 Cadenasso Dr
Fairfield, CA 94533-6806
Mailing address
2059 Cadenasso Dr
Fairfield, CA 94533-6806
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 |
|---|---|---|---|
| 77646 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551052800000",
"number": "1447717566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2059 CADENASSO DR",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945336806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2059 CADENASSO DR",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945336806",
"telephone_number": "707-759-0005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONG",
"first_name": "JUSTIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-02-25",
"last_updated": "2019-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "77646",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.