Provider Demographics
NPI:1801399910
Name:TAYONG, KAREN NGUM
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:NGUM
Last Name:TAYONG
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 1:1201 N WATSON RD STE 220
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-6120
Mailing Address - Country:US
Mailing Address - Phone:817-902-6500
Mailing Address - Fax:
Practice Address - Street 1:1201 N WATSON RD STE 220
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-6120
Practice Address - Country:US
Practice Address - Phone:817-902-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2069559225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant