Healthcare Provider Details

I. General information

NPI: 1245368109
Provider Name (Legal Business Name): MATTHEW CHRISTOPHER JEONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 STANYAN ST RM T4-33
SAN FRANCISCO CA
94117
US

IV. Provider business mailing address

450 STANYAN ST RM T4-33
SAN FRANCISCO CA
94117-1019
US

V. Phone/Fax

Practice location:
  • Phone: 415-668-1000
  • Fax: 415-750-8156
Mailing address:
  • Phone: 415-668-1000
  • Fax: 415-750-8156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA87010
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA87010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: