Provider Demographics
NPI:1558388231
Name:MARK L. TONG, MD INC.
Entity Type:Organization
Organization Name:MARK L. TONG, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LEX
Authorized Official - Last Name:TONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-344-9200
Mailing Address - Street 1:1000 FOWLER WAY
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5738
Mailing Address - Country:US
Mailing Address - Phone:530-344-9200
Mailing Address - Fax:530-344-9010
Practice Address - Street 1:1000 FOWLER WAY
Practice Address - Street 2:SUITE 1A
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5738
Practice Address - Country:US
Practice Address - Phone:530-344-9200
Practice Address - Fax:530-344-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG080662Medicaid
CAF44396Medicare UPIN
CA00G806620Medicare ID - Type Unspecified