Provider Demographics
NPI:1558310599
Name:CHIONG, VICENTE ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:VICENTE
Middle Name:ANTHONY
Last Name:CHIONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:V.
Other - Middle Name:ANTHONY
Other - Last Name:CHIONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1133 E STANLEY BLVD
Mailing Address - Street 2:#103
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4200
Mailing Address - Country:US
Mailing Address - Phone:925-455-5050
Mailing Address - Fax:925-455-5084
Practice Address - Street 1:1133 E STANLEY BLVD
Practice Address - Street 2:#103
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4200
Practice Address - Country:US
Practice Address - Phone:925-455-5050
Practice Address - Fax:925-455-5084
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69163208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics