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General NPI Number Information
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NPI Number | 1578024519
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Entity Type | Individual
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Provider Name | STACEY GUO CHONG
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Gender | Female
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Dates
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Enumeration Date | 03/30/2019
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 8821 NE 5TH ST
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City | VANCOUVER
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State | WA
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Zip | 98664
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Country | US
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Telephone | 360-514-2340
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Fax | 360-514-2345
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Provider Business Mailing Address
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Address Line | 505 NE 87TH AVE STE 460
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City | VANCOUVER
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State | WA
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Zip | 98664-1965
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Country | US
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Telephone | 360-514-2340
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | MD61483707
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | A176604
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License Number State | CA
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