Provider Demographics
NPI:1891815791
Name:CHONG, JOSEBELO D (MD)
Entity Type:Individual
Prefix:
First Name:JOSEBELO
Middle Name:D
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 1:1801 E MARCH LN
Mailing Address - Street 2:SUITE C 300
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-6629
Mailing Address - Country:US
Mailing Address - Phone:209-464-6422
Mailing Address - Fax:209-464-0193
Practice Address - Street 1:1801 E MARCH LN
Practice Address - Street 2:SUITE C 300
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-6629
Practice Address - Country:US
Practice Address - Phone:209-464-6422
Practice Address - Fax:209-464-0193
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC135303174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M74460158Medicare PIN