Provider Demographics
NPI:1164688099
Name:DYHIANTO, CHRISTIAN EDWARD ONG (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN EDWARD
Middle Name:ONG
Last Name:DYHIANTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6912 FM 1488 RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-1527
Mailing Address - Country:US
Mailing Address - Phone:281-356-1945
Mailing Address - Fax:281-356-1978
Practice Address - Street 1:6912 FM 1488 RD
Practice Address - Street 2:SUITE A
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-1527
Practice Address - Country:US
Practice Address - Phone:281-356-1945
Practice Address - Fax:281-356-1978
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2014-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXN3626207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206170703Medicaid
TX206170703Medicaid
TXH54E - 8L15608Medicare PIN
TXC458 - 206170701Medicaid