| Doctor Name: | MISS ROSA T ONG |
| NPI Number: | 1669731675 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 36054291 |
| Business Practice Address: | 3430 N Lake Shore Dr Apt 7l Chicago, IL - 606572834 |
| Business Phone Number: | 7732489821 |
| Business Fax Number: | 7732489821 |
| Mailing Address: | 3430 N Lake Shore Dr Apt 7l, CHICAGO |
| State: | IL |
| Postal Code: | 606572834 |
| Phone Number: | 7732489821 |
| Fax Number: | 7732489821 |
| NPI Enumeration Date: | 05/10/2012 |
| NPI Last Update Date: | 05/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 36054291 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |