Provider Demographics
NPI:1548454457
Name:TONG, DIEULIEN (DDS)
Entity type:Individual
Prefix:
First Name:DIEULIEN
Middle Name:
Last Name:TONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 NORTH JACKSON AVENUE
Mailing Address - Street 2:STE. # 10
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116
Mailing Address - Country:US
Mailing Address - Phone:408-254-3333
Mailing Address - Fax:408-254-3394
Practice Address - Street 1:229 NORTH JACKSON AVE.
Practice Address - Street 2:STE. # 10
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116
Practice Address - Country:US
Practice Address - Phone:408-254-3333
Practice Address - Fax:408-254-3394
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD 40501122300000X
CAD40501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist