Provider Demographics
NPI:1033447875
Name:CHON, MUN BONG
Entity Type:Individual
Prefix:MR
First Name:MUN BONG
Middle Name:
Last Name:CHON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9307 N LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-4103
Mailing Address - Country:US
Mailing Address - Phone:512-339-8666
Mailing Address - Fax:512-339-1950
Practice Address - Street 1:9307 N LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-4103
Practice Address - Country:US
Practice Address - Phone:512-339-8666
Practice Address - Fax:512-339-1950
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist