Healthcare Provider Details

I. General information

NPI: 1285952002
Provider Name (Legal Business Name): BENNY YEE-CHUN CHONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PARK DR SUITE 400
CONCORD NC
28025-2982
US

IV. Provider business mailing address

200 MEDICAL PARK DR SUITE 400
CONCORD NC
28025-2982
US

V. Phone/Fax

Practice location:
  • Phone: 704-786-1108
  • Fax: 704-782-1826
Mailing address:
  • Phone: 704-262-1642
  • Fax: 704-782-1826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberME122679
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number2016-00657
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: