Provider Demographics
NPI:1649755315
Name:SANDJONG, LIONEL
Entity Type:Individual
Prefix:
First Name:LIONEL
Middle Name:
Last Name:SANDJONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 N KIRBYWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7512
Mailing Address - Country:US
Mailing Address - Phone:847-660-8213
Mailing Address - Fax:
Practice Address - Street 1:2108 N KIRBYWOOD TRL
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7512
Practice Address - Country:US
Practice Address - Phone:847-660-8213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX931240163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse