MEDICARE: ILSONG JASON CHONG, M.D.,P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	K4025	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0089HL	OTHER		BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063698934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILSONG JASON CHONG, M.D.,P.A.

Provider Business Mailing Address
First Line	:	2410 ELLA BLVD
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77008-2710
Country	:	US
Telephone Number	:	713-861-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2410 ELLA BLVD
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77008-2710
Country	:	US
Telephone Number	:	713-861-5000
Fax Number	:	713-861-5040

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ILSONG JASON CHONG
Credential	:	M.D.
Telephone Number	:	713-861-5000

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	10/14/2009

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