Provider Demographics
NPI:1730449729
Name:CHONG, JENNIFER (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CHONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 WEST LOOP S STE 420
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4124
Mailing Address - Country:US
Mailing Address - Phone:713-266-9955
Mailing Address - Fax:713-266-9956
Practice Address - Street 1:6750 WEST LOOP S STE 420
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4124
Practice Address - Country:US
Practice Address - Phone:713-266-9955
Practice Address - Fax:713-266-9956
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ4734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FF556OtherBLUE CROSS BLUE SHIELD
TX350029001Medicaid
TX8FF556OtherBLUE CROSS BLUE SHIELD