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NPI Code Detail

MEDICARE: CHONG LIEU M.D

MEDICARE: CHONG LIEU 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
1207Q00000XFamily Medicine Physician22139NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659375178
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHONG LIEU M.D
Provider Business Mailing Address
First Line : 930 W WILSON AVE
Second Line :
City : MOORESVILLE
State : NC
Zip : 28117-8811
Country : US
Telephone Number : 704-663-7500
Fax Number : 704-799-2613
Provider Business Practice Location Address
First Line : 930 W WILSON AVE
Second Line :
City : MOORESVILLE
State : NC
Zip : 28117-8811
Country : US
Telephone Number : 704-663-7500
Fax Number : 704-799-2613
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 02/22/2008

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Directions to “ CHONG LIEU M.D” Practice Location

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