MEDICARE: DR. JOHN YOHAN CHONG M.D.

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	207W00000X	Ophthalmology Physician	0101243232	VA

General Provider Information

NPI Number	:	1326219429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN YOHAN CHONG M.D.

Provider Business Mailing Address
First Line	:	5900 FORT DR
Second Line	:	SUITE 301
City	:	CENTREVILLE
State	:	VA
Zip	:	20121-2425
Country	:	US
Telephone Number	:	571-210-5535
Fax Number	:	703-376-8865

Provider Business Practice Location Address
First Line	:	5900 FORT DR
Second Line	:	SUITE 301
City	:	CENTREVILLE
State	:	VA
Zip	:	20121-2425
Country	:	US
Telephone Number	:	571-210-5535
Fax Number	:	703-376-8865

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	03/24/2014

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