Provider Demographics
NPI:1346313228
Name:CHEN, JONG L (MD)
Entity Type:Individual
Prefix:DR
First Name:JONG
Middle Name:L
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JONG
Other - Middle Name:LIANG
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3941 J ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3624
Mailing Address - Country:US
Mailing Address - Phone:916-733-6800
Mailing Address - Fax:916-733-6811
Practice Address - Street 1:3941 J ST
Practice Address - Street 2:SUITE 250
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3624
Practice Address - Country:US
Practice Address - Phone:916-733-6800
Practice Address - Fax:916-733-6811
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC-37462174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C374621Medicaid
CA00C374621Medicaid
CA00C374621Medicare ID - Type Unspecified