Provider Demographics
NPI:1548698475
Name:KHONG, TOMMY
Entity type:Individual
Prefix:
First Name:TOMMY
Middle Name:
Last Name:KHONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TUAN
Other - Middle Name:
Other - Last Name:KHONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1119 W PIONEER PKWY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-7604
Mailing Address - Country:US
Mailing Address - Phone:857-459-3311
Mailing Address - Fax:
Practice Address - Street 1:1119 W PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-7604
Practice Address - Country:US
Practice Address - Phone:817-459-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX015797374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide