Provider Demographics
NPI:1972681542
Name:CHONG, KOK L (MD)
Entity Type:Individual
Prefix:
First Name:KOK
Middle Name:L
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 1:2720 US HIGHWAY 1 S STE C
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6371
Mailing Address - Country:US
Mailing Address - Phone:904-320-0680
Mailing Address - Fax:904-320-0800
Practice Address - Street 1:2720 US HIGHWAY 1 S STE C
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6371
Practice Address - Country:US
Practice Address - Phone:904-320-0680
Practice Address - Fax:904-320-0800
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA635172085R0204X
FLME1058412085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001743900Medicaid
FL001743900Medicaid
FLCT529TMedicare PIN
FL001743900Medicaid