Healthcare Provider Details

I. General information

NPI: 1790426351
Provider Name (Legal Business Name): BRANDON LEE CHONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 4TH ST # MS 9410
LUBBOCK TX
79430-0002
US

IV. Provider business mailing address

5250 RIDGELINE DR
BROWNSVILLE TX
78526-3882
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-1088
  • Fax: 806-743-3143
Mailing address:
  • Phone: 956-579-5840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV1754
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: