Healthcare Provider Details

I. General information

NPI: 1053144741
Provider Name (Legal Business Name): ELAIN WEN-SHANG TONG, DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 ENDEAVOR STE 304
IRVINE CA
92618-3177
US

IV. Provider business mailing address

18 ENDEAVOR STE 304
IRVINE CA
92618-3177
US

V. Phone/Fax

Practice location:
  • Phone: 714-556-8664
  • Fax: 714-556-8665
Mailing address:
  • Phone: 714-556-8664
  • Fax: 714-556-8665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELAIN TONG
Title or Position: PRESIDENT
Credential: DO
Phone: 714-556-8664