Provider Demographics
NPI:1386655413
Name:DONG, TAMMY M (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:M
Last Name:DONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 BEYER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-2009
Mailing Address - Country:US
Mailing Address - Phone:619-428-4463
Mailing Address - Fax:619-428-2625
Practice Address - Street 1:865 3RD AVE
Practice Address - Street 2:SUITE #133
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911
Practice Address - Country:US
Practice Address - Phone:619-498-6200
Practice Address - Fax:619-427-0134
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66903208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FHC70394FOtherMEDI CAL
W5740BMedicare ID - Type Unspecified
H56301Medicare UPIN