MEDICARE: DR. MARIA TERESA CHONG MD

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	207Q00000X	Family Medicine Physician	8045	NV

General Provider Information

NPI Number	:	1811478613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA TERESA CHONG MD

Provider Business Mailing Address
First Line	:	PO BOX 34716
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-4716
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 N MARTIN L KING BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2825
Country	:	US
Telephone Number	:	702-967-0530
Fax Number	:

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

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	08/28/2018

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