Provider Demographics
NPI:1366547598
Name:CHONG, JENNY (DDS)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:CHONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5167 CLAYTON RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-3167
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5167 CLAYTON RD
Practice Address - Street 2:SUITE E
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-3167
Practice Address - Country:US
Practice Address - Phone:925-827-5595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice