Healthcare Provider Details

I. General information

NPI: 1578425419
Provider Name (Legal Business Name): DORCAS JING TENG CHONG RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 N 12TH ST FL 2
PHOENIX AZ
85006-2837
US

IV. Provider business mailing address

2228 N 52ND ST UNIT 143
PHOENIX AZ
85008-3445
US

V. Phone/Fax

Practice location:
  • Phone: 602-521-5180
  • Fax:
Mailing address:
  • Phone: 269-806-8076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86446782
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: