Provider Demographics
NPI:1962713701
Name:LO, CHAURONG (MD)
Entity type:Individual
Prefix:
First Name:CHAURONG
Middle Name:
Last Name:LO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 161ST ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1606
Mailing Address - Country:US
Mailing Address - Phone:718-939-9792
Mailing Address - Fax:
Practice Address - Street 1:3519 161ST ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1606
Practice Address - Country:US
Practice Address - Phone:718-939-9792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-26
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167699207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine