Provider Demographics
NPI:1164610713
Name:TONG, ELAIN WEN-SHANG (DO)
Entity Type:Individual
Prefix:
First Name:ELAIN
Middle Name:WEN-SHANG
Last Name:TONG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54188
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-4188
Mailing Address - Country:US
Mailing Address - Phone:714-556-8664
Mailing Address - Fax:714-556-8665
Practice Address - Street 1:18 ENDEAVOR STE 304
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3177
Practice Address - Country:US
Practice Address - Phone:714-556-8664
Practice Address - Fax:714-556-8665
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 9893207LP2900X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine