1215311386 NPI number — DR. JIA RONG CHONG M.D.

Table of content: DR. JIA RONG CHONG M.D. (NPI 1215311386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215311386 NPI number — DR. JIA RONG CHONG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHONG
Provider First Name:
JIA
Provider Middle Name:
RONG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHONG
Provider Other First Name:
JARON
Provider Other Middle Name:
JIA RONG
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1215311386
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
360 STATE ST #2005
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
779-206-6678
Provider Business Mailing Address Fax Number:
203-737-1688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 CEDAR STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-785-5253
Provider Business Practice Location Address Fax Number:
203-737-1688
Provider Enumeration Date:
07/17/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X , with the licence number:  54335 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 54335 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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