Provider Demographics
NPI:1558450445
Name:TONG, JIAN (MD)
Entity type:Individual
Prefix:
First Name:JIAN
Middle Name:
Last Name:TONG
Suffix:
Gender:M
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-3199
Practice Address - Fax:682-885-7499
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3866207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137318512OtherMEDICAID CSHCN
TX111896OtherSUPERIOR PIN
TX137345805Medicaid
TX1122972OtherFIRSTHEALTH PIN
TX10024131OtherAMERIGROUP PIN
TX00L42VOtherBCBSTX GRP PIN
TX137283103Medicaid
TX137318511Medicaid
TX1848675OtherUHC PIN
TX5280639OtherAETNA PIN
TX125616100OtherFIRSTCARE PIN
TX137318508Medicaid
TX137318507Medicaid
1669442042OtherGRP NPI NUMBER
TX6950882OtherCIGNA PIN
TX8A0212OtherBCBSTX IND PIN
TX00L42VMedicare PIN
TX1848675OtherUHC PIN
TX125616100OtherFIRSTCARE PIN
TX137318508Medicaid