Provider Demographics
NPI:1629368774
Name:CHONG, CHERYL (DO)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:CHONG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:821 SAINT HELENA HWY S
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-2266
Mailing Address - Country:US
Mailing Address - Phone:707-967-7551
Mailing Address - Fax:
Practice Address - Street 1:821 SAINT HELENA HWY S
Practice Address - Street 2:SUITE 2
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-2266
Practice Address - Country:US
Practice Address - Phone:707-967-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A14403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine