Basic Information
| Provider Information | |||||||||
| NPI: | 1609371137 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHONG | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 347 NORTH KUAKINI STREET | ||||||||
| Address2: | HPM-9 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085238461 | ||||||||
| FaxNumber: | 8085281897 | ||||||||
| Practice Location | |||||||||
| Address1: | 347 N KUAKINI ST | ||||||||
| Address2: | HPM 9 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968172306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085238461 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2018 | ||||||||
| LastUpdateDate: | 11/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | FL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RG0300X | MD-21740 | HI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.