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General NPI Number Information
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NPI Number | 1386707875
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Entity Type | Individual
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Provider Name | KRISTINE C CHONG D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 33800 ALVARADO NILES RD STE 6
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City | UNION CITY
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State | CA
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Zip | 94587-4359
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Country | US
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Telephone | 510-477-6727
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Fax |
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Provider Business Mailing Address
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Address Line | 255 N SAN MATEO DR STE 3
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City | SAN MATEO
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State | CA
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Zip | 94401-2671
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Country | US
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Telephone | 650-342-1512
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 49293
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License Number State | CA
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