Provider Demographics
NPI:1275367815
Name:LIFETIME MD HEALTH LLC
Entity type:Organization
Organization Name:LIFETIME MD HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-214-8473
Mailing Address - Street 1:7790 W GRAND PKWY S STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-5830
Mailing Address - Country:US
Mailing Address - Phone:281-214-8473
Mailing Address - Fax:281-214-8476
Practice Address - Street 1:7790 W GRAND PKWY S STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5830
Practice Address - Country:US
Practice Address - Phone:281-214-8473
Practice Address - Fax:281-214-8476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty