Basic Information
Provider Information
NPI: 1003011917
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHONG
FirstName: NYEN
MiddleName: V
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1802 S YAKIMA
Address2: STE 102
City: TACOMA
State: WA
PostalCode: 984055303
CountryCode: US
TelephoneNumber: 2532727777
FaxNumber: 2534264142
Practice Location
Address1: 1802 S YAKIMA
Address2: STE 102
City: TACOMA
State: WA
PostalCode: 984055303
CountryCode: US
TelephoneNumber: 2532727777
FaxNumber: 2534264142
Other Information
ProviderEnumerationDate: 06/19/2007
LastUpdateDate: 08/17/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208G00000XMD60136570WAY Allopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery) 

ID Information
IDTypeStateIssuerDescription
029391901WAL&IOTHER
026540701WASTATE L&IOTHER
029257401WAL&IOTHER
G889594601WAMEDICAREOTHER
G890964601WAMEDICAREOTHER
P0092114001WARR MEDICAREOTHER


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