Provider Demographics
NPI:1164896353
Name:TIONGSON, EDWARD
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:TIONGSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 N KIMBALL AVE
Mailing Address - Street 2:BSMT APT
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4522
Mailing Address - Country:US
Mailing Address - Phone:773-540-6638
Mailing Address - Fax:
Practice Address - Street 1:5701 N KIMBALL AVE
Practice Address - Street 2:BSMT APT
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4522
Practice Address - Country:US
Practice Address - Phone:773-540-6638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057004410224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant