Provider Demographics
NPI:1356395073
Name:CHONG, MING TA (MD)
Entity type:Individual
Prefix:
First Name:MING
Middle Name:TA
Last Name:CHONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:675 ARROYO PKWY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105
Mailing Address - Country:US
Mailing Address - Phone:626-585-4122
Mailing Address - Fax:626-395-5274
Practice Address - Street 1:675 ARROYO PKWY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:626-585-4122
Practice Address - Fax:626-395-5274
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-11-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA29483207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A83964Medicare UPIN