Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A103352 | CA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | A103352 | CA |
NPI | 1174774806 |
---|---|
Provider Name | Matthew D Chong |
First Address | Los Angeles, CA 90033-2424 |
Second Address | Los Angeles, CA 90045-1543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2008 |
Last Update Date | 04/02/2021 |