Provider Demographics
NPI:1306901335
Name:HONE, CHONG SAN (MD)
Entity type:Individual
Prefix:DR
First Name:CHONG
Middle Name:SAN
Last Name:HONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PHILIP
Other - Middle Name:CHONGSAN
Other - Last Name:HONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:17170 COLIMA RD
Mailing Address - Street 2:STE# G
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6771
Mailing Address - Country:US
Mailing Address - Phone:626-810-0706
Mailing Address - Fax:626-810-9829
Practice Address - Street 1:17170 COLIMA RD.
Practice Address - Street 2:STE# G
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6813
Practice Address - Country:US
Practice Address - Phone:626-810-0706
Practice Address - Fax:626-810-9829
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49271208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A492710Medicaid
CAE98949Medicare UPIN
CAWA49271AMedicare PIN