Provider Demographics
NPI:1104030188
Name:CHONG, CHANG HUN (OMD)
Entity Type:Individual
Prefix:DR
First Name:CHANG
Middle Name:HUN
Last Name:CHONG
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 28585GMF BARRIGADA, GU 96921
Mailing Address - Street 2:SUITE 1C 2068 LOUTUS BUILDING ROUTE 16
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96921
Mailing Address - Country:US
Mailing Address - Phone:671-637-4443
Mailing Address - Fax:
Practice Address - Street 1:SUITE 1C 2068 LOUTUS BUILDING ROUTE 16
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929
Practice Address - Country:US
Practice Address - Phone:671-637-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3776171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist