Provider Demographics
NPI:1124082144
Name:TONG, ELISA K (MD)
Entity type:Individual
Prefix:DR
First Name:ELISA
Middle Name:K
Last Name:TONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELISA
Other - Middle Name:K
Other - Last Name:ONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4150 V ST
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-7236
Mailing Address - Fax:916-734-2732
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:SUITE 100, GENERAL MEDICINE CLINIC B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A7713600Medicaid
CA0A7713600Medicaid
CAH80930Medicare UPIN