Healthcare Provider Details

I. General information

NPI: 1376031328
Provider Name (Legal Business Name): JANICE KIM CHONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15820 ADDISON RD
ADDISON TX
75001-3549
US

IV. Provider business mailing address

1301 N A W GRIMES BLVD APT 1724
ROUND ROCK TX
78665-3484
US

V. Phone/Fax

Practice location:
  • Phone: 214-575-2999
  • Fax:
Mailing address:
  • Phone: 510-387-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: