Healthcare Provider Details

I. General information

NPI: 1487027512
Provider Name (Legal Business Name): SOOK LING CHONG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BREN RD E
MINNETONKA MN
55343-9664
US

IV. Provider business mailing address

420 PARK PL APT 5C
FORT LEE NJ
07024-3750
US

V. Phone/Fax

Practice location:
  • Phone: 646-387-1588
  • Fax:
Mailing address:
  • Phone: 646-387-1588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number339912
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number339912
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: