Provider Demographics
NPI:1023045317
Name:RUTH PILPA TIONGSON MD INC
Entity Type:Organization
Organization Name:RUTH PILPA TIONGSON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:PILPA
Authorized Official - Last Name:TIONGSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-512-3767
Mailing Address - Street 1:PO BOX 93064
Mailing Address - Street 2:ATTN: SUSAN
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109-3064
Mailing Address - Country:US
Mailing Address - Phone:818-512-3767
Mailing Address - Fax:
Practice Address - Street 1:2520 LAS LUNAS ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-2625
Practice Address - Country:US
Practice Address - Phone:818-683-8721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37013207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID NUMBER