Provider Demographics
NPI:1053984047
Name:VONG, CHRISTINE (AUD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:VONG
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 W TOKAY ST STE 4
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3842
Mailing Address - Country:US
Mailing Address - Phone:209-368-9222
Mailing Address - Fax:209-368-4664
Practice Address - Street 1:1101 W TOKAY ST STE 4
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3842
Practice Address - Country:US
Practice Address - Phone:209-368-9222
Practice Address - Fax:209-368-4664
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU3601237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter