MEDICARE: ISAAC CHONG DDS

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	1223G0001X	General Practice Dentistry	101442	CA

General Provider Information

NPI Number	:	1558881151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAAC CHONG DDS

Provider Business Mailing Address
First Line	:	25229 TAYLOR ST APT A
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-3032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3115 LATTE LN # 100
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93312-2141
Country	:	US
Telephone Number	:	661-587-7002
Fax Number	:

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

Provider Enumeration Date	:	06/23/2017
Last Update Date	:	06/23/2017

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