Provider Demographics
NPI:1164690442
Name:THAO, CHONG PAO
Entity Type:Individual
Prefix:
First Name:CHONG
Middle Name:PAO
Last Name:THAO
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 1:1770 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106
Mailing Address - Country:US
Mailing Address - Phone:651-293-1033
Mailing Address - Fax:651-224-1057
Practice Address - Street 1:23 EMPIRE DRIVE
Practice Address - Street 2:SUITE 123
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103
Practice Address - Country:US
Practice Address - Phone:651-222-2787
Practice Address - Fax:651-224-1057
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant