Provider Demographics
NPI:1316553431
Name:JUNAEDY-TONG, EVELINE (DDS)
Entity Type:Individual
Prefix:
First Name:EVELINE
Middle Name:
Last Name:JUNAEDY-TONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1367 BEL AIRE RD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3616
Mailing Address - Country:US
Mailing Address - Phone:415-813-7699
Mailing Address - Fax:
Practice Address - Street 1:1367 BEL AIRE RD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3616
Practice Address - Country:US
Practice Address - Phone:415-813-7699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1055571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice