Healthcare Provider Details

I. General information

NPI: 1518858307
Provider Name (Legal Business Name): PHILIP SONGIL CHONG MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7707 AUSTIN RD
STOCKTON CA
95215-8312
US

IV. Provider business mailing address

4030 E MORADA LN APT 12204
STOCKTON CA
95212-1661
US

V. Phone/Fax

Practice location:
  • Phone: 209-467-2500
  • Fax:
Mailing address:
  • Phone: 281-684-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: