Provider Demographics
NPI:1881654739
Name:HONG, TINA SANDY (MD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:SANDY
Last Name:HONG
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 1:11875 DUBLIN BLVD
Mailing Address - Street 2:SUITE B 125
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2843
Mailing Address - Country:US
Mailing Address - Phone:925-587-2500
Mailing Address - Fax:925-587-2511
Practice Address - Street 1:1359 PARK ST
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4533
Practice Address - Country:US
Practice Address - Phone:510-523-8162
Practice Address - Fax:510-865-2532
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64539208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics