Provider Demographics
NPI:1578092672
Name:ALBERT CHONG, JENNIFER (RD CD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ALBERT CHONG
Suffix:
Gender:F
Credentials:RD CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1791 NE 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-4301
Mailing Address - Country:US
Mailing Address - Phone:360-678-8278
Mailing Address - Fax:
Practice Address - Street 1:1791 NE 1ST AVE
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-4301
Practice Address - Country:US
Practice Address - Phone:360-678-8278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty