Healthcare Provider Details

I. General information

NPI: 1114118361
Provider Name (Legal Business Name): DIANA NGOC TON D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 SE BAYBERRY LN 101
LEES SUMMIT MO
64063-4389
US

IV. Provider business mailing address

676 SE BAYBERRY LN 101
LEES SUMMIT MO
64063-4389
US

V. Phone/Fax

Practice location:
  • Phone: 816-434-5906
  • Fax: 816-434-5907
Mailing address:
  • Phone: 816-434-5906
  • Fax: 816-434-5907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2009033094
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number12-00375
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: