Provider Demographics
NPI:1952755662
Name:CHONG, JILLIAN KIMBERLY (MD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:KIMBERLY
Last Name:CHONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14445 OLIVE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-1437
Mailing Address - Country:US
Mailing Address - Phone:818-364-3205
Mailing Address - Fax:
Practice Address - Street 1:416 N BEDFORD DR STE 300
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4309
Practice Address - Country:US
Practice Address - Phone:310-273-2333
Practice Address - Fax:310-273-6583
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA172936207W00000X, 207WX0120X
OH35.139074207W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program