Provider Demographics
NPI:1740384775
Name:CHONG, ELISA LEI (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:LEI
Last Name:CHONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 AULIMA LOOP
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3932
Mailing Address - Country:US
Mailing Address - Phone:808-342-7767
Mailing Address - Fax:808-529-4950
Practice Address - Street 1:800 S KING ST FL 3
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3010
Practice Address - Country:US
Practice Address - Phone:808-529-4949
Practice Address - Fax:808-529-4950
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-66363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIR17850Medicare UPIN
HIVAD000Medicare UPIN