Provider Demographics
NPI:1811203896
Name:STEPHEN K. CHOONG, MD PC
Entity Type:Organization
Organization Name:STEPHEN K. CHOONG, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHOONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-661-6765
Mailing Address - Street 1:501 NE HOOD AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7303
Mailing Address - Country:US
Mailing Address - Phone:503-661-6765
Mailing Address - Fax:503-661-6789
Practice Address - Street 1:501 NE HOOD AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7303
Practice Address - Country:US
Practice Address - Phone:503-661-6765
Practice Address - Fax:503-661-6789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10395208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR03349-8Medicaid
OR03349-8Medicaid
OR0000BHHTBMedicare PIN