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General NPI Number Information
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NPI Number | 1669731675
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Entity Type | Individual
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Provider Name | ROSA T ONG MD
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Gender | Female
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Dates
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Enumeration Date | 05/10/2012
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Last Update Date | 05/10/2012
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Provider Practice Location Address
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Address Line | 3430 N LAKE SHORE DR APT 7L
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City | CHICAGO
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State | IL
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Zip | 60657-2834
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Country | US
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Telephone | 773-248-9821
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Fax | 773-248-9821
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Provider Business Mailing Address
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Address Line | 3430 N LAKE SHORE DR APT 7L
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City | CHICAGO
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State | IL
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Zip | 60657-2834
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Country | US
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Telephone | 773-248-9821
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Fax | 773-248-9821
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 36054291
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License Number State | IL
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