Healthcare Provider Details

I. General information

NPI: 1811203896
Provider Name (Legal Business Name): STEPHEN K. CHOONG, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 NE HOOD AVE SUITE 205
GRESHAM OR
97030-7303
US

IV. Provider business mailing address

501 NE HOOD AVE SUITE 205
GRESHAM OR
97030-7303
US

V. Phone/Fax

Practice location:
  • Phone: 503-661-6765
  • Fax: 503-661-6789
Mailing address:
  • Phone: 503-661-6765
  • Fax: 503-661-6789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number10395
License Number StateOR

VIII. Authorized Official

Name: DR. STEPHEN K CHOONG
Title or Position: OWNER
Credential: MD
Phone: 503-661-6765