{
"Npi": {
"NPI": "1295928976",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "TONG",
"FirstName": "CONNIE CHIA-YING",
"MiddleName": null,
"NamePrefix": "MISS",
"NameSuffix": null,
"Credential": "M.S.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "TONG",
"OtherFirstName": "CONNIE",
"OtherMiddleName": null,
"OtherNamePrefix": "MISS",
"OtherNameSuffix": null,
"OtherCredential": "M.S.",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "10808 FOOTHILL BLVD STE 160829",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RANCHO CUCAMONGA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91730-3889",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-325-8124",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "10808 FOOTHILL BLVD STE 160829",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RANCHO CUCAMONGA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91730-3889",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "626-325-8124",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/24/2007",
"LastUpdateDate": "12/14/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "235Z00000X",
"TaxonomyName": "Speech-Language Pathologist",
"LicenseNumber": "SP15580",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}