Healthcare Provider Details

I. General information

NPI: 1750463329
Provider Name (Legal Business Name): SUONG MY TUONG MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5296 UNIVERSITY AVENUE SUITE J
SAN DIEGO CA
92105-2269
US

IV. Provider business mailing address

5296 UNIVERSITY AVENUE SUITE J
SAN DIEGO CA
92105-2269
US

V. Phone/Fax

Practice location:
  • Phone: 619-287-7835
  • Fax: 619-287-2307
Mailing address:
  • Phone: 619-287-7835
  • Fax: 619-287-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA36173
License Number StateCA

VIII. Authorized Official

Name: SUONG MY TUONG
Title or Position: OWNER GENERAL PARTNER
Credential: MD
Phone: 619-287-7835