Healthcare Provider Details

I. General information

NPI: 1023578721
Provider Name (Legal Business Name): JULIA TONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

588 EL CAMINO REAL UNIT 329
SANTA CLARA CA
95050-4585
US

V. Phone/Fax

Practice location:
  • Phone: 408-387-4144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA177557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: