Healthcare Provider Details

I. General information

NPI: 1235914391
Provider Name (Legal Business Name): BRIAN H TONG AGPCNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 11/29/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 S ROBERTSON BLVD
LOS ANGELES CA
90035-1613
US

IV. Provider business mailing address

822 S ROBERTSON BLVD STE 100
LOS ANGELES CA
90035-1630
US

V. Phone/Fax

Practice location:
  • Phone: 310-651-6937
  • Fax:
Mailing address:
  • Phone: 310-651-6937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95026808
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: