Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A114923 | CA |
N | 208600000X | Surgeon | A114923 | CA |
Y | 208200000X | Surgeon | Q1116 | TX |
Y | 208600000X | Surgeon | Q1116 | TX |
N | 2086S0102X | Surgical Critical Care | Q1116 | TX |
NPI | 1326275744 |
---|---|
Provider Name | Jonathan Chong |
First Address | Augusta, GA 30914-2187 |
Second Address | Plano, TX 75075-6172 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2009 |
Last Update Date | 05/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RES000 | (02) | CA |