Healthcare Provider Details

I. General information

NPI: 1790198455
Provider Name (Legal Business Name): TONGLE YU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 THIRD ST SUITE 200
WICHITA FALLS TX
76301
US

IV. Provider business mailing address

100 PATRIOTS RD
STONY BROOK NY
11790-3318
US

V. Phone/Fax

Practice location:
  • Phone: 940-767-5145
  • Fax:
Mailing address:
  • Phone: 631-444-8608
  • Fax: 631-444-8778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number291889
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: