Healthcare Provider Details

I. General information

NPI: 1841292521
Provider Name (Legal Business Name): CHEST MEDICINE AND CRITICAL CARE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 FROST ST STE 401
SAN DIEGO CA
92123-4209
US

IV. Provider business mailing address

8008 FROST ST STE 401
SAN DIEGO CA
92123-4209
US

V. Phone/Fax

Practice location:
  • Phone: 858-309-5931
  • Fax: 858-810-6908
Mailing address:
  • Phone: 858-309-5931
  • Fax: 858-810-6908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAVIES Y. WONG
Title or Position: PRESIDENT
Credential: MD
Phone: 858-309-5931