Provider Demographics
NPI:1245328897
Name:CHIONG, DESMOND B (MD)
Entity type:Individual
Prefix:DR
First Name:DESMOND
Middle Name:B
Last Name:CHIONG
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 1:1455 SAN MARINO AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2033
Mailing Address - Country:US
Mailing Address - Phone:626-577-9010
Mailing Address - Fax:626-577-9129
Practice Address - Street 1:1455 SAN MARINO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2033
Practice Address - Country:US
Practice Address - Phone:626-577-9010
Practice Address - Fax:626-577-9129
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA315772084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A315771Medicaid
CAW2983BOtherGROUP MEDICARE NUMBER
CAWA31577AOtherPPIN
CAW2983BOtherGROUP MEDICARE NUMBER
CAWA31577AOtherPPIN