Basic Information
| Provider Information | |||||||||
| NPI: | 1952698516 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHONG | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 770 KAPIOLANI BLVD | ||||||||
| Address2: | SUITE 705 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968135212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085978778 | ||||||||
| FaxNumber: | 8085978781 | ||||||||
| Practice Location | |||||||||
| Address1: | 770 KAPIOLANI BLVD | ||||||||
| Address2: | SUITE 705 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968135212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085978778 | ||||||||
| FaxNumber: | 8085978781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2011 | ||||||||
| LastUpdateDate: | 08/25/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD17442 | HI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | MD17442 | 01 | HI | MEDICAL LICENSE | OTHER |