Healthcare Provider Details

I. General information

NPI: 1891975835
Provider Name (Legal Business Name): LIJUAN TONG MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 W HOUSTON ST STE 306
SAN ANTONIO TX
78205-2140
US

IV. Provider business mailing address

PO BOX 701543
SAN ANTONIO TX
78270-1543
US

V. Phone/Fax

Practice location:
  • Phone: 210-577-0673
  • Fax: 210-247-9699
Mailing address:
  • Phone: 210-497-1528
  • Fax: 210-247-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL9936
License Number StateTX

VIII. Authorized Official

Name: DR. LIJUAN TONG
Title or Position: PRESIDENT
Credential: MD
Phone: 210-577-0673