Healthcare Provider Details

I. General information

NPI: 1922230317
Provider Name (Legal Business Name): KA-YAN TONG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 SHORES DR
METAIRIE LA
70006
US

IV. Provider business mailing address

4509 SHORES DR
METAIRIE LA
70006
US

V. Phone/Fax

Practice location:
  • Phone: 504-885-2535
  • Fax: 504-885-8119
Mailing address:
  • Phone: 504-885-2535
  • Fax: 504-885-8119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberMD201733
License Number StateLA

VIII. Authorized Official

Name: DR. KA-YAN TONG
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 504-885-2535