Provider Demographics
NPI:1932134756
Name:CHONG, MARIBETH (MD)
Entity Type:Individual
Prefix:
First Name:MARIBETH
Middle Name:
Last Name:CHONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 PRIESTLY DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-8812
Mailing Address - Country:US
Mailing Address - Phone:760-434-6060
Mailing Address - Fax:760-434-6565
Practice Address - Street 1:5930 PRIESTLY DR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-8812
Practice Address - Country:US
Practice Address - Phone:760-434-6060
Practice Address - Fax:760-434-6565
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51324207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG31914Medicare UPIN
CAC51324Medicare PIN