Healthcare Provider Details

I. General information

NPI: 1609825611
Provider Name (Legal Business Name): KOK-HENG CHONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24929 GODDARD RD
TAYLOR MI
48180-3930
US

IV. Provider business mailing address

5910 W RAINTREE CT
YPSILANTI MI
48197-7126
US

V. Phone/Fax

Practice location:
  • Phone: 734-946-2061
  • Fax:
Mailing address:
  • Phone: 312-399-9652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2901018078
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: