MEDICARE: DR. CHRISTOPHER KOON SING JONG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A94265	CA

General Provider Information

NPI Number	:	1336336700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER KOON SING JONG M.D.

Provider Business Mailing Address
First Line	:	1616 FAIR OAKS AVE
Second Line	:	# 14
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4739
Country	:	US
Telephone Number	:	626-818-3112
Fax Number	:

Provider Business Practice Location Address
First Line	:	1616 FAIR OAKS AVE
Second Line	:	# 14
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4739
Country	:	US
Telephone Number	:	626-818-3112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	06/13/2024

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