Provider Demographics
NPI:1700056314
Name:TONG, WINNIE MAO YIU (MD)
Entity Type:Individual
Prefix:
First Name:WINNIE
Middle Name:MAO YIU
Last Name:TONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WINNIE
Other - Middle Name:
Other - Last Name:TONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7945 WOLF RIVER BLVD STE 290
Mailing Address - Street 2:UT MEDICAL GROUP, DEPT OF PLASTIC SURGERY
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-866-8525
Mailing Address - Fax:901-302-2525
Practice Address - Street 1:7945 WOLF RIVER BLVD STE 290
Practice Address - Street 2:UT MEDICAL GROUP, DEPT OF PLASTIC SURGERY
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-866-8525
Practice Address - Fax:901-302-2525
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN489952086S0122X
CAA88471208600000X
TXP8316208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX328758301 (MDACC)Medicaid
TX8EC549OtherBCBS (MDACC)
TX328758301 (MDACC)Medicaid