Provider Demographics
NPI:1851413124
Name:TONGBAI, SOMSONG (MD)
Entity Type:Individual
Prefix:DR
First Name:SOMSONG
Middle Name:
Last Name:TONGBAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 S MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5715
Mailing Address - Country:US
Mailing Address - Phone:714-564-9323
Mailing Address - Fax:714-973-8885
Practice Address - Street 1:611 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5715
Practice Address - Country:US
Practice Address - Phone:714-564-9323
Practice Address - Fax:714-973-8885
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31437261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center