Provider Demographics
NPI:1003159526
Name:ROSS, TIFFANY PONG (PA-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:PONG
Last Name:ROSS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:WING-GI
Other - Last Name:PONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 PARNASSUS AVE
Mailing Address - Street 2:3RD FLOOR, SUITE 311
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 PARNASSUS AVE
Practice Address - Street 2:3RD FLOOR, SUITE 311
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2202
Practice Address - Country:US
Practice Address - Phone:415-353-2739
Practice Address - Fax:415-353-4047
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant