Provider Demographics
NPI:1568659159
Name:TUONG, SUONG MY (MD)
Entity Type:Individual
Prefix:DR
First Name:SUONG
Middle Name:MY
Last Name:TUONG
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 1:5296 UNIVERSITY AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-2269
Mailing Address - Country:US
Mailing Address - Phone:619-287-7835
Mailing Address - Fax:619-287-2307
Practice Address - Street 1:5296 UNIVERSITY AVE
Practice Address - Street 2:SUITE J
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-2269
Practice Address - Country:US
Practice Address - Phone:619-287-7835
Practice Address - Fax:619-287-2307
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36173207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A361730Medicaid
CAA36173Medicare PIN
CA00A361730Medicaid