Active NPI
Samuel John Gong, PHARM D
- Pharmacist
- Glendale, CA
National Provider Identifier
1538638531
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 73202
- Practice address
- 1809 Verdugo Blvd Ste 110
Glendale, CA 91208-1402 - Phone
- (818) 928-1304
- Fax
- (818) 928-1305
- NPI assigned
- Nov 19, 2018
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 73202 | CA | Primary |
Addresses
Primary practice location
1809 Verdugo Blvd Ste 110
Glendale, CA 91208-1402
Mailing address
2106 Yosemite Dr
Los Angeles, CA 90041-2702
Phone (310) 780-0735
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 73202 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mid-Wilshire Health Inc | Current | Accepting new patients |
Locations
1809 Verdugo Blvd
Ste 110
Glendale, CA 91208
Phone (818) 928-1304
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542585600000",
"number": "1538638531",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2106 YOSEMITE DR",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900412702",
"telephone_number": "310-780-0735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1809 VERDUGO BLVD STE 110",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912081402",
"telephone_number": "818-928-1304",
"fax_number": "818-928-1305"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONG",
"first_name": "SAMUEL",
"middle_name": "JOHN",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-11-19",
"last_updated": "2018-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "73202",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.