Individual
TAE KAE CHONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2705 N LEBANON ST STE 315, LEBANON, IN 46052-8622
(765) 485-8855
(765) 485-8850
Mailing address
2605 N LEBANON ST, LEBANON, IN 46052-1476
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01039705A
IN
207RN0300X
Nephrology Physician
Primary
01039705A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100363470
—
IN
Enumeration date
09/16/2005
Last updated
10/10/2023
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