MEDICARE: KOK L. 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	2085R0204X	Vascular & Interventional Radiology Physician	A63517	CA
2	2085R0204X	Vascular & Interventional Radiology Physician	ME105841	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1972681542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOK L. CHONG MD

Provider Business Mailing Address
First Line	:	2720 US HIGHWAY 1 S STE C
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-6371
Country	:	US
Telephone Number	:	904-320-0680
Fax Number	:	904-320-0800

Provider Business Practice Location Address
First Line	:	2720 US HIGHWAY 1 S STE C
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-6371
Country	:	US
Telephone Number	:	904-320-0680
Fax Number	:	904-320-0800

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/21/2022

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Directions to “ KOK L. CHONG MD” Practice Location

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