Provider Demographics
NPI:1497786040
Name:CHONG, MELODY (DPM)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:CHONG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 475312
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94147-5312
Mailing Address - Country:US
Mailing Address - Phone:415-386-3338
Mailing Address - Fax:415-386-3300
Practice Address - Street 1:3838 CALIFORNIA ST
Practice Address - Street 2:STE. 601
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1522
Practice Address - Country:US
Practice Address - Phone:415-386-3338
Practice Address - Fax:415-386-3300
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2011-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3838213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E38380Medicaid
CA000E38380Medicaid
U33588Medicare UPIN