Healthcare Provider Details

I. General information

NPI: 1396954186
Provider Name (Legal Business Name): TAE W CHONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 11/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12605 E 16TH AVE UNIVERSITY OF COLORADO HOSPITAL
AURORA CO
80045
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-0000
  • Fax:
Mailing address:
  • Phone: 303-493-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberN5627
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberDR.0054794
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberDR.0054794
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: