MEDICARE: CHONG SHROUT CO

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	222Z00000X	Orthotist
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1629261581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHONG SHROUT CO

Provider Business Mailing Address
First Line	:	2761 GEARY BLVD
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-3405
Country	:	US
Telephone Number	:	415-387-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2761 GEARY BLVD
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-3405
Country	:	US
Telephone Number	:	415-387-8500
Fax Number	:

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

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	08/23/2007

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Directions to “ CHONG SHROUT CO” Practice Location

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