Provider Demographics
NPI:1639738834
Name:CHONG, MARIA TZE-KWAN (RPH)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:TZE-KWAN
Last Name:CHONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-3650
Mailing Address - Country:US
Mailing Address - Phone:323-773-2025
Mailing Address - Fax:323-773-9124
Practice Address - Street 1:7101 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-3650
Practice Address - Country:US
Practice Address - Phone:323-773-2025
Practice Address - Fax:323-773-9124
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist