MEDICARE: DR. DOMINIC JUN FAI TONG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	G58453	CA
2	208D00000X	General Practice Physician	G58453	CA

General Provider Information

NPI Number	:	1528369535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINIC JUN FAI TONG M.D.

Provider Business Mailing Address
First Line	:	122 15TH STREET, BOX 2445
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-1745
Country	:	US
Telephone Number	:	858-342-3156
Fax Number	:

Provider Business Practice Location Address
First Line	:	13773 BOQUITA DR
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-3409
Country	:	US
Telephone Number	:	858-342-3156
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2010
Last Update Date	:	05/05/2015

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