Individual
KASENG DEREK CHAN-PONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1223 GATEWAY DR STE B, MELBOURNE, FL 32901-2607
(321) 725-4500
(321) 952-2330
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 361-5613
(321) 951-7408
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
ME73216
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
259780200
—
FL
01
—
49928Y
MEDICARE
FL
Enumeration date
10/27/2005
Last updated
04/04/2019
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