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General NPI Number Information
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NPI Number | 1063698934
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Entity Type | Organization
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Legal Business Name | ILSONG JASON CHONG, M.D.,P.A.
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 10/14/2009
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Provider Practice Location Address
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Address Line | 2410 ELLA BLVD SUITE B
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City | HOUSTON
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State | TX
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Zip | 77008-2710
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Country | US
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Telephone | 713-861-5000
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Fax | 713-861-5040
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Provider Business Mailing Address
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Address Line | 2410 ELLA BLVD SUITE B
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City | HOUSTON
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State | TX
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Zip | 77008-2710
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Country | US
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Telephone | 713-861-5000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ILSONG JASON CHONG
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Credential | M.D.
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Telephone | 713-861-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | K4025
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License Number State | TX
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