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General NPI Number Information
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NPI Number | 1356911176
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Entity Type | Individual
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Provider Name | HUIYONG CHONG GOODYEAR-FASSIHI PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/25/2021
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 1545 E LEIGHFIELD DR STE 100
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City | MERIDIAN
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State | ID
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Zip | 83646-5371
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Country | US
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Telephone | 208-957-6871
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Fax |
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Provider Business Mailing Address
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Address Line | 1545 E LEIGHFIELD DR STE 100
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City | MERIDIAN
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State | ID
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Zip | 83646-5371
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Country | US
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Telephone | 208-957-6871
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | CNP67749
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License Number State | ID
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