Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | G53507 | CA |
NPI | 1093937112 |
---|---|
Provider Name | Dr. Penny Jean Chong |
First Address | Agoura Hills, CA 91301-4233 |
Second Address | Agoura Hills, CA 91301-4233 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 01/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E02735 | (02) | CA |