Provider Demographics
NPI:1396021002
Name:CHONG, JESSICA S (DPM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:S
Last Name:CHONG
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:13768 ROSWELL AVE
Mailing Address - Street 2:SUITE #107
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1401
Mailing Address - Country:US
Mailing Address - Phone:909-464-1401
Mailing Address - Fax:909-464-1397
Practice Address - Street 1:13768 ROSWELL AVE
Practice Address - Street 2:SUITE #107
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1401
Practice Address - Country:US
Practice Address - Phone:909-464-1401
Practice Address - Fax:909-464-1397
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2012-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAEL1807213ES0103X
CAE4985213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery