Basic Information
| Provider Information | |||||||||
| NPI: | 1992901219 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHONG | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | DANIEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 501724 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921501724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584537700 | ||||||||
| FaxNumber: | 8587981225 | ||||||||
| Practice Location | |||||||||
| Address1: | 16466 BERNARDO CENTER DR | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921282508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584537700 | ||||||||
| FaxNumber: | 8587981225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2007 | ||||||||
| LastUpdateDate: | 04/04/2016 | ||||||||
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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 | 208100000X | MDR-5065 | HI | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2081P2900X | A103353 | CA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.