JACK VONG (NPI# 1417374554) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417374554 |
| Entity Type | Individual |
| Full Name | JACK VONG |
| Practice Address |
4633 Old Ironsides Dr Suite 101 Santa Clara CA 95054-1807 |
| Practice Telephone | 4088558608 |
| Mailing Telephone | 4088558608 |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2014-03-26 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 28757 | CA | Chiropractic Providers |
| Street Address |
4633 OLD IRONSIDES DR SUITE 101 |
| City | SANTA CLARA |
| State | CA |
| Zip Code | 95054-1807 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629621552 | Pushpa Bhandari | Behavior Technician | 3170 De Lacruz Blvd, Suite 107, Santa Clara, CA 95054 | 2019-07-19 |
| 1275001679 | Janet Johnston-tyler | Counselor | 4655 Old Ironsides Dr., Suite 170, Santa Clara, CA 95054 | 2018-11-05 |
| 1184106643 | Sunshine Acupuncture & Healthcare | Acupuncturist | 3350 Scott Blvd., #28-2, Santa Clara, CA 95054 | 2018-08-31 |
| 1538654496 | Molly Delaney | Speech-Language Pathologist | 4701 Patrick Henry Dr., Bldg 23 Suite D, Santa Clara, CA 95054 | 2018-06-24 |
| 1255826111 | Jordan Moore | Speech-Language Pathologist | 4701 Patrick Henry Dr., Bldg 23, Suite D, Santa Clara, CA 95054 | 2018-06-24 |
| 1073008934 | Tanya Guerrero | Speech-Language Pathologist | 4701 Patrick Henry Drive., Bldg 23, Suite D, Santa Clara, CA 95054 | 2018-06-24 |
| 1366931305 | Jacqueline Genna | Speech-Language Pathologist | 4701 Patrick Henry Drive, Bldg 23 Suite D, Santa Clara, CA 95054 | 2018-05-04 |
| 1386131886 | Angel Raynetta Stevens | Behavior Technician | 3170 Dela Cruz Blvd., Ste 107, Santa Clara, CA 95054 | 2018-04-19 |
| 1528567468 | Ledia Mati | Chiropractor | 3700 Thomas Rd Ste 207, Santa Clara, CA 95054 | 2018-02-06 |
| 1982133310 | Hien Tue Nguyen | Pharmacist | 3970 Rivermark Plaza, Santa Clara, CA 95054 | 2017-06-08 |
| Find all providers in zip 95054 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770191694 | Elevate Functional Health, LLC | Chiropractor | 667 Sweetspring Dr, Santa Clara, UT 84765-5469 | 2020-07-16 |
| 1669939310 | Melissa Shizuka Tashiro | Chiropractor | 160 Saratoga Ave Ste 140, Santa Clara, CA 95051-7334 | 2019-02-28 |
| 1528567468 | Ledia Mati | Chiropractor | 3700 Thomas Rd Ste 207, Santa Clara, CA 95054 | 2018-02-06 |
| 1124545496 | Lori Kristine Cruz | Chiropractor | 4675 Stevens Creek Blvd Ste 215, Santa Clara, CA 95051-6764 | 2017-08-27 |
| 1144684457 | Jordan Michael Jiunta | Chiropractor | 3505 The Alameda, Santa Clara, CA 95050-4334 | 2016-04-12 |
| 1932500345 | Tae Hyun Lee | Chiropractor | 3216 El Camino Real # 9, Santa Clara, CA 95051-2803 | 2014-09-05 |
| 1245598366 | Young Hee Ro | Chiropractor | 100 Saratoga Ave, Santa Clara, CA 95051-7337 | 2012-04-26 |
| 1124390067 | Karo Isajan | Chiropractor | 5145 Stevens Creek Blvd Ste 130, Santa Clara, CA 95051 | 2012-02-08 |
| 1164711891 | Connie Yeonhee Chung | Chiropractor | 3148 El Camino Real Ste 107, Santa Clara, CA 95051-2930 | 2011-04-04 |
| 1760792295 | Antonio Dominic Rodriguez | Chiropractor | 2545 Armstrong Place, Santa Clara, CA 95050-5511 | 2010-10-18 |
| Find all providers in SANTA CLARA | ||||
| City | SANTA CLARA |
| Zip Code | 95054 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.