Provider Demographics
NPI:1174574560
Name:TONG, HARRISON H (DO)
Entity type:Individual
Prefix:
First Name:HARRISON
Middle Name:H
Last Name:TONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2050 BLUE OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-6506
Practice Address - Country:US
Practice Address - Phone:916-910-2500
Practice Address - Fax:916-910-2501
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8685207Q00000X
WI47811-021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2015113OtherPHYSICIANS PLUS
WI60449OtherDEAN HEALTH INSURANCE
WI43520800Medicaid
H99367Medicare UPIN
WI741501670Medicare PIN
WI045354340Medicare PIN
WI60449OtherDEAN HEALTH INSURANCE
WIP00456485Medicare PIN