Provider Demographics
NPI:1205845906
Name:CHONG, WINCHA (MD)
Entity Type:Individual
Prefix:DR
First Name:WINCHA
Middle Name:
Last Name:CHONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2591 MIAMISBURG CENTERVILLE ROAD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3706
Mailing Address - Country:US
Mailing Address - Phone:937-433-7622
Mailing Address - Fax:937-433-7656
Practice Address - Street 1:3130 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1337
Practice Address - Country:US
Practice Address - Phone:937-440-4896
Practice Address - Fax:937-440-4381
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060186642085R0202X
OH350940252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4272171OtherMEDICARE
OH2990018Medicaid