Individual provider Active NPI

Khanh Kristine Tong, O.D.

  • Optometrist
  • Westminster, CA
National Provider Identifier
1033296645
Registry record updated Jan 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
11759T Issued in CA
Practice address
9741 Bolsa Ave
Suite #115
Westminster, CA 92683-6683
Phone
(714) 839-9915
Fax
(714) 839-9974
NPI assigned
Nov 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 11759T CA Primary

Addresses

Primary practice location

9741 Bolsa Ave
Suite #115
Westminster, CA 92683-6683

Mailing address

9741 Bolsa Ave
Suite #115
Westminster, CA 92683-6683
Phone (714) 839-9915

Other identifiers 1

IdentifierTypeStateIssuer
SD0117590MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211217001695 CA Practitioner - Optometry 1052702537 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11759TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Khanh Kristine Tong, O.D., Inc Optometrist CurrentSince Nov 19, 2021 Accepting new patients

Locations

9741 Bolsa Ave
Ste 115
Westminster, CA 92683
Phone (714) 839-9915

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326067200000",
    "number": "1033296645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9741 BOLSA AVE",
            "address_2": "SUITE #115",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926836683",
            "telephone_number": "714-839-9915",
            "fax_number": "714-839-9974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9741 BOLSA AVE",
            "address_2": "SUITE #115",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926836683",
            "telephone_number": "714-839-9915",
            "fax_number": "714-839-9974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TONG",
        "first_name": "KHANH",
        "middle_name": "KRISTINE",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2012-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11759T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0117590",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Westminster, CA

Sources for this page

Verify at the official NPI Registry.