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General NPI Number Information
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NPI Number | 1639175425
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Entity Type | Individual
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Provider Name | LIJUAN TONG MD
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Gender | Female
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 04/01/2013
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Provider Practice Location Address
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Address Line | 343 W HOUSTON ST STE 306
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City | SAN ANTONIO
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State | TX
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Zip | 78205-2140
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Country | US
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Telephone | 210-577-0673
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Fax | 210-247-9699
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Provider Business Mailing Address
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Address Line | PO BOX 701543
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City | SAN ANTONIO
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State | TX
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Zip | 78270-1543
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Country | US
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Telephone | 210-497-1528
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Fax | 210-247-9699
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | L9936
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License Number State | TX
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