Provider Demographics
NPI:1770363335
Name:CHI, CLETUS FONCHINGONG (RRT)
Entity type:Individual
Prefix:
First Name:CLETUS
Middle Name:FONCHINGONG
Last Name:CHI
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:CLETUS
Other - Middle Name:FONCHINGONG
Other - Last Name:CHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5664 OAKVIEW TER
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011
Mailing Address - Country:US
Mailing Address - Phone:919-884-1088
Mailing Address - Fax:
Practice Address - Street 1:5664 OAKVIEW TER
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45011
Practice Address - Country:US
Practice Address - Phone:919-884-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRCP.14456207PE0004X
2279E0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2279E0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredEmergency CareGroup - Multi-Specialty
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services