Provider Demographics
NPI:1073043006
Name:TONG, YANNIE (PA-C)
Entity Type:Individual
Prefix:
First Name:YANNIE
Middle Name:
Last Name:TONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:YANNIE
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:780 WELCH RD
Mailing Address - Street 2:STE 106
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5102
Mailing Address - Country:US
Mailing Address - Phone:650-723-4000
Mailing Address - Fax:
Practice Address - Street 1:780 WELCH RD
Practice Address - Street 2:STE 106
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5102
Practice Address - Country:US
Practice Address - Phone:650-723-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54471363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant