Provider Demographics
NPI:1275723967
Name:DO, MATTHEW CHONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CHONG
Last Name:DO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SUENG
Other - Middle Name:CHONG
Other - Last Name:DO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:100 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3324
Mailing Address - Country:US
Mailing Address - Phone:209-535-3469
Mailing Address - Fax:831-373-1744
Practice Address - Street 1:100 PARK AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3324
Practice Address - Country:US
Practice Address - Phone:831-373-4116
Practice Address - Fax:831-373-1744
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-28
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA454521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD45452Medicaid