Healthcare Provider Details

I. General information

NPI: 1073975710
Provider Name (Legal Business Name): KELLY TONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7848 OLD YORK RD STE 200D KELLY TONG
ELKINS PARK PA
19027-2541
US

IV. Provider business mailing address

7848 OLD YORK RD STE 200D KELLY TONG
ELKINS PARK PA
19027-2541
US

V. Phone/Fax

Practice location:
  • Phone: 215-867-0198
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAK001179
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: