Healthcare Provider Details

I. General information

NPI: 1700056314
Provider Name (Legal Business Name): WINNIE MAO YIU TONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WINNIE TONG M.D.

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7945 WOLF RIVER BLVD STE 290 UT MEDICAL GROUP, DEPT OF PLASTIC SURGERY
GERMANTOWN TN
38138
US

IV. Provider business mailing address

7945 WOLF RIVER BLVD STE 290 UT MEDICAL GROUP, DEPT OF PLASTIC SURGERY
GERMANTOWN TN
38138
US

V. Phone/Fax

Practice location:
  • Phone: 901-866-8525
  • Fax: 901-302-2525
Mailing address:
  • Phone: 901-866-8525
  • Fax: 901-302-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberP8316
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA88471
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number48995
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: