Healthcare Provider Details

I. General information

NPI: 1689307761
Provider Name (Legal Business Name): ANGELINA DANIELLE TONG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S ELLSWORTH AVE STE 801
SAN MATEO CA
94401-3926
US

IV. Provider business mailing address

7556 CHARMANT DR APT 1722
SAN DIEGO CA
92122-5056
US

V. Phone/Fax

Practice location:
  • Phone: 650-344-0299
  • Fax:
Mailing address:
  • Phone: 408-568-7172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDDS107820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: