Provider Demographics
NPI:1093749715
Name:CHIONG, DOMINIC MAUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:MAUNG
Last Name:CHIONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5196 APENNINES CIR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2317
Mailing Address - Country:US
Mailing Address - Phone:408-531-9611
Mailing Address - Fax:
Practice Address - Street 1:2690 S WHITE RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-2077
Practice Address - Country:US
Practice Address - Phone:408-223-8118
Practice Address - Fax:408-223-8188
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69952207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F17353Medicare UPIN