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Individual
DR. THEN ETHAN VAN TONG
Active
Individual
DR. THEN ETHAN VAN TONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4475
IA
390200000X
Student in an Organized Health Care Education/Training Program
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447578992
—
IA
01
—
P01242999
RR MEDICARE
IA
Enumeration date
05/08/2010
Last updated
01/20/2014
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