Healthcare Provider Details

I. General information

NPI: 1023907011
Provider Name (Legal Business Name): CHONG VUE FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5241 N MAPLE AVE
FRESNO CA
93740-8996
US

IV. Provider business mailing address

5241 N MAPLE AVE
FRESNO CA
93740-0001
US

V. Phone/Fax

Practice location:
  • Phone: 559-278-4240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95035650
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95035650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: