Provider Demographics
NPI:1255529517
Name:JEN MANN CHUONGMDPA
Entity type:Organization
Organization Name:JEN MANN CHUONGMDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHUONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-880-0131
Mailing Address - Street 1:2310 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GUN BARREL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75156-3636
Mailing Address - Country:US
Mailing Address - Phone:903-880-0131
Mailing Address - Fax:
Practice Address - Street 1:2310 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-3636
Practice Address - Country:US
Practice Address - Phone:903-880-0131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00907TMedicare PIN