Provider Demographics
NPI:1649535600
Name:CHONG, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CHONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 PONDEROSA AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2034
Mailing Address - Country:US
Mailing Address - Phone:714-392-6975
Mailing Address - Fax:
Practice Address - Street 1:1319 PONDEROSA AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2034
Practice Address - Country:US
Practice Address - Phone:714-392-6975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant