Healthcare Provider Details

I. General information

NPI: 1093099046
Provider Name (Legal Business Name): JUN R. CHIONG, MD, MPH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 TENNESSEE ST STE C
REDLANDS CA
92373-8161
US

IV. Provider business mailing address

461 TENNESSEE ST STE C
REDLANDS CA
92373-8161
US

V. Phone/Fax

Practice location:
  • Phone: 909-475-7371
  • Fax:
Mailing address:
  • Phone: 909-475-7371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA95516
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA95516
License Number StateCA

VIII. Authorized Official

Name: DR. JUN CHIONG
Title or Position: PRESIDENT
Credential: MD, MPH
Phone: 909-475-7371