Provider Demographics
NPI:1639705122
Name:TONG, PUI YAN (MS, RD)
Entity Type:Individual
Prefix:
First Name:PUI
Middle Name:YAN
Last Name:TONG
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14942 LAGO DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MURIETA
Mailing Address - State:CA
Mailing Address - Zip Code:95683-9532
Mailing Address - Country:US
Mailing Address - Phone:732-763-0173
Mailing Address - Fax:
Practice Address - Street 1:120 SAN LUCAR CT
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-5213
Practice Address - Country:US
Practice Address - Phone:855-816-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86018646133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered