=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508194820
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FELIX CHION-FONG MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2009
-----------------------------------------------------
Last Update Date | 11/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6365 COLLINS AVE APT 1411
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33141-9620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-907-2648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6365 COLLINS AVE APT 1411
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33141-9620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-907-2648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | FELIX CHION-FONG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-868-0250
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | ME68838
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------