Healthcare Provider Details

I. General information

NPI: 1730875337
Provider Name (Legal Business Name): ALEXANDER CHONG MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12720 BASS LAKE RD
MAPLE GROVE MN
55369-6307
US

IV. Provider business mailing address

12720 BASS LAKE RD
MAPLE GROVE MN
55369-6307
US

V. Phone/Fax

Practice location:
  • Phone: 763-559-2861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number82262
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: