MEDICARE: JUAN TONG APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	53-84278-052	KS

General Provider Information

NPI Number	:	1447047972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN TONG APRN

Provider Business Mailing Address
First Line	:	2905 N WILD ROSE CT
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67205-1639
Country	:	US
Telephone Number	:	608-844-9678
Fax Number	:

Provider Business Practice Location Address
First Line	:	2905 N WILD ROSE CT
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67205-1639
Country	:	US
Telephone Number	:	608-844-9678
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2025
Last Update Date	:	04/21/2025

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