Healthcare Provider Details

I. General information

NPI: 1598730590
Provider Name (Legal Business Name): JUN R CHIONG M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
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: 855-233-7921
Mailing address:
  • Phone: 909-475-7371
  • Fax: 855-233-7921

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:
Title or Position:
Credential:
Phone: