Healthcare Provider Details

I. General information

NPI: 1497786040
Provider Name (Legal Business Name): MELODY CHONG DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 CALIFORNIA ST STE. 601
SAN FRANCISCO CA
94118-1522
US

IV. Provider business mailing address

PO BOX 475312
SAN FRANCISCO CA
94147-5312
US

V. Phone/Fax

Practice location:
  • Phone: 415-386-3338
  • Fax: 415-386-3300
Mailing address:
  • Phone: 415-386-3338
  • Fax: 415-386-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE3838
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: