Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | K3866 | TX |
NPI | 1558450445 |
---|---|
Provider Name | Jian Tong |
First Address | Dallas, TX 75373-3784 |
Second Address | Fort Worth, TX 76104-2733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 04/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G58564 | (02) |