=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215326236
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDY CHEN DOONG MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2015
-----------------------------------------------------
Last Update Date | 11/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6536 S MCCARRAN BLVD STE B
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89509-6152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-982-8255
-----------------------------------------------------
Fax | 775-982-8251
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1155 MILL ST # M14
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89502-1576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-982-5262
-----------------------------------------------------
Fax | 775-982-5496
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 26155
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207ND0101X
-----------------------------------------------------
Taxonomy Name | MOHS-Micrographic Surgery Physician
-----------------------------------------------------
License Number | 26155
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------