Healthcare Provider Details

I. General information

NPI: 1053659995
Provider Name (Legal Business Name): PAIN ALLEVIA MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15611 POMERADO RD SUITE 525
POWAY CA
92064-2437
US

IV. Provider business mailing address

PO BOX 5333
TORRANCE CA
90510-5333
US

V. Phone/Fax

Practice location:
  • Phone: 858-613-6252
  • Fax: 858-798-1225
Mailing address:
  • Phone: 714-777-2469
  • Fax: 714-777-2427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA103353
License Number StateCA

VIII. Authorized Official

Name: DR. TIMOTHY DANIEL CHONG
Title or Position: OWNER/ PRESIDENT
Credential: M.D.
Phone: 808-392-0512