Provider Demographics
NPI:1255207262
Name:CHONG SUE, STEVEN
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:CHONG SUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 BUELL ST STE A2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-2861
Mailing Address - Country:US
Mailing Address - Phone:707-322-1507
Mailing Address - Fax:
Practice Address - Street 1:3824 BUELL ST STE A2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-2861
Practice Address - Country:US
Practice Address - Phone:510-422-3959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician