Provider Demographics
NPI:1336645621
Name:CHONG, ALBERTO BENJAMIN (DO)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:BENJAMIN
Last Name:CHONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 S SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-5440
Mailing Address - Country:US
Mailing Address - Phone:918-619-4726
Mailing Address - Fax:
Practice Address - Street 1:8005 E 106TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6600
Practice Address - Country:US
Practice Address - Phone:918-634-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK6633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program