Provider Demographics
NPI:1780219949
Name:TONG, THUY K
Entity Type:Individual
Prefix:
First Name:THUY
Middle Name:K
Last Name:TONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23444 MOUNTAIN BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5033
Mailing Address - Country:US
Mailing Address - Phone:951-331-3888
Mailing Address - Fax:
Practice Address - Street 1:31700 GRAPE ST
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-9785
Practice Address - Country:US
Practice Address - Phone:951-245-4329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59528183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist