Provider Demographics
NPI:1336173285
Name:CHON, SUSAN YA MING (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:YA MING
Last Name:CHON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 HOLCOMBE BLVD UNIT 434
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4009
Mailing Address - Country:US
Mailing Address - Phone:713-745-1113
Mailing Address - Fax:713-745-3597
Practice Address - Street 1:1515 HOLCOMBE BLVD UNIT 434
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4009
Practice Address - Country:US
Practice Address - Phone:713-745-1113
Practice Address - Fax:713-745-3597
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66191207N00000X
TXL9142207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A661910OtherMEDICAL PPIN #
CAH34210Medicare UPIN
CA00A661910OtherMEDICAL PPIN #