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General NPI Number Information
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NPI Number | 1528762705
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Entity Type | Individual
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Provider Name | JINA CHONG OD
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Gender | Female
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Dates
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Enumeration Date | 03/30/2023
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 1391 WOODSIDE RD STE 200
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City | REDWOOD CITY
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State | CA
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Zip | 94061-3574
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Country | US
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Telephone | 650-368-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 338 S FREMONT ST APT 209
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City | SAN MATEO
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State | CA
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Zip | 94401-3375
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Country | US
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Telephone | 202-805-3069
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4669ATI
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License Number State | OR
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