Provider Demographics
NPI:1265698864
Name:CHONG, LINUS (DDS)
Entity type:Individual
Prefix:
First Name:LINUS
Middle Name:
Last Name:CHONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 SAN MARINO AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2052
Mailing Address - Country:US
Mailing Address - Phone:626-583-4921
Mailing Address - Fax:626-583-4923
Practice Address - Street 1:1477 SAN MARINO AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2052
Practice Address - Country:US
Practice Address - Phone:626-583-4921
Practice Address - Fax:626-583-4923
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-03
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA523601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics