Provider Demographics
NPI:1750463329
Name:SUONG MY TUONG MD
Entity Type:Organization
Organization Name:SUONG MY TUONG MD
Other - Org Name:NGOC MINH PHAM MD & SUONG MY TUONG MD APC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SUONG
Authorized Official - Middle Name:MY
Authorized Official - Last Name:TUONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-287-7835
Mailing Address - Street 1:5296 UNIVERSITY AVENUE
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 AVENUE
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36173207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A361730Medicaid
CAA36173Medicare PIN
B50317Medicare UPIN