Provider Demographics
NPI:1952353435
Name:CHONG, DENNIS (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
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 1:10001 S EASTERN AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3907
Mailing Address - Country:US
Mailing Address - Phone:702-617-1981
Mailing Address - Fax:702-616-1105
Practice Address - Street 1:10001 S EASTERN AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3907
Practice Address - Country:US
Practice Address - Phone:702-617-1981
Practice Address - Fax:702-616-1105
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7402208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019625Medicaid
NV002019625Medicaid
F49485Medicare UPIN