Provider Demographics
NPI:1558387027
Name:CHIONG, LOLITA (MD)
Entity Type:Individual
Prefix:MRS
First Name:LOLITA
Middle Name:
Last Name:CHIONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LOLITA
Other - Middle Name:
Other - Last Name:CHIONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:31776 ALVARADO BLVD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-5800
Mailing Address - Country:US
Mailing Address - Phone:510-487-4400
Mailing Address - Fax:510-487-7682
Practice Address - Street 1:31776 ALVARADO BLVD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-5800
Practice Address - Country:US
Practice Address - Phone:510-487-4400
Practice Address - Fax:510-487-7682
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A297080Medicaid
00A297080Medicare ID - Type Unspecified
CA00A297080Medicaid