1487186946 NPI number — REGEN PAIN MANAGEMENT

Table of content: DR. MATTHEW CHONG DO DDS (NPI 1275723967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487186946 NPI number — REGEN PAIN MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGEN PAIN MANAGEMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487186946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6957 W PLANO PKWY
Provider Second Line Business Mailing Address:
SUITE 2300
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-252-7477
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6957 W PLANO PKWY
Provider Second Line Business Practice Location Address:
SUITE 2300
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-1620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-252-7477
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KONING
Authorized Official First Name:
DR JONATHAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
469-252-4777

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  Q0953 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)