MEDICARE: DR. JONATHAN T CHONG PT, DPT

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	225100000X	Physical Therapist	PT293914	CA

General Provider Information

NPI Number	:	1851806004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN T CHONG PT, DPT

Provider Business Mailing Address
First Line	:	4140 W 190TH ST
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-5513
Country	:	US
Telephone Number	:	310-967-1889
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 E MAPLE AVE
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-6507
Country	:	US
Telephone Number	:	310-316-6190
Fax Number	:

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

Provider Enumeration Date	:	12/11/2017
Last Update Date	:	04/01/2024

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