Provider Demographics
NPI:1992901219
Name:CHONG, TIMOTHY DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DANIEL
Last Name:CHONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 501724
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92150-1724
Mailing Address - Country:US
Mailing Address - Phone:858-453-7700
Mailing Address - Fax:858-798-1225
Practice Address - Street 1:16466 BERNARDO CENTER DR
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2508
Practice Address - Country:US
Practice Address - Phone:858-453-7700
Practice Address - Fax:858-798-1225
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-24
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMDR-5065208100000X
CAA1033532081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation