Provider Demographics
NPI:1871531178
Name:STRONG, HOWARD EVAN (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:EVAN
Last Name:STRONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EVAN
Other - Middle Name:
Other - Last Name:STRONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:39270 PASEO PADRE PKWY
Mailing Address - Street 2:SUITE 518
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1616
Mailing Address - Country:US
Mailing Address - Phone:510-795-8186
Mailing Address - Fax:510-792-8186
Practice Address - Street 1:39233 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1501
Practice Address - Country:US
Practice Address - Phone:510-795-8186
Practice Address - Fax:510-792-8186
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16796174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G167960Medicaid
CA00G167960Medicare ID - Type Unspecified
CA00G167962Medicare PIN
CA00G167960Medicaid
CAA39911Medicare UPIN