Provider Demographics
NPI:1790709939
Name:CHONG, ANTHONY FATCHHIV (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:FATCHHIV
Last Name:CHONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:760-827-7260
Mailing Address - Fax:
Practice Address - Street 1:2176 SALK AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7346
Practice Address - Country:US
Practice Address - Phone:760-827-7260
Practice Address - Fax:760-827-7215
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A780040Medicaid
CAH88170Medicare UPIN
CA00A780040Medicaid