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: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 FROST STREET SUITE 245
SAN DIEGO CA
92123
US

IV. Provider business mailing address

7910 FROST STREET SUITE 245
SAN DIEGO CA
92123
US

V. Phone/Fax

Practice location:
  • Phone: 858-650-5036
  • Fax: 858-650-5039
Mailing address:
  • Phone: 858-650-5036
  • Fax: 858-650-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVIES Y. WONG
Title or Position: PRESIDENT
Credential: MD
Phone: 858-650-5036