Provider Demographics
NPI:1639175425
Name:TONG, LIJUAN (MD)
Entity Type:Individual
Prefix:
First Name:LIJUAN
Middle Name:
Last Name:TONG
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:PO BOX 701543
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78270-1543
Mailing Address - Country:US
Mailing Address - Phone:210-497-1528
Mailing Address - Fax:210-247-9699
Practice Address - Street 1:343 W HOUSTON ST STE 306
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2140
Practice Address - Country:US
Practice Address - Phone:210-577-0673
Practice Address - Fax:210-247-9699
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2013-04-01
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
TXL9936174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167943302Medicaid
TX8F0228Medicare PIN