Provider Demographics
NPI:1346269073
Name:CHONG, CHIN-SHEE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHIN-SHEE
Middle Name:
Last Name:CHONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3630
Mailing Address - Country:US
Mailing Address - Phone:781-821-2140
Mailing Address - Fax:781-821-2140
Practice Address - Street 1:442 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-3630
Practice Address - Country:US
Practice Address - Phone:781-821-2140
Practice Address - Fax:781-821-2140
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51817208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB97770Medicare UPIN
MAJ03986Medicare ID - Type Unspecified