MEDICARE: LEONARD SCOTT CHONG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	47703	CA

General Provider Information

NPI Number	:	1548833726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD SCOTT CHONG DDS

Provider Business Mailing Address
First Line	:	33800 ALVARADO NILES RD STE 1
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4359
Country	:	US
Telephone Number	:	510-489-5671
Fax Number	:	510-489-5676

Provider Business Practice Location Address
First Line	:	33800 ALVARADO NILES RD STE 1
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4359
Country	:	US
Telephone Number	:	510-489-5671
Fax Number	:	510-489-5676

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2021
Last Update Date	:	07/23/2021

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Directions to “ LEONARD SCOTT CHONG DDS” Practice Location

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