Individual
JEREMY WONG CHIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
18436 ROSCOE BLVD, NORTHRIDGE, CA 91325-4107
(818) 435-1400
Mailing address
4100 GUARDIAN ST STE 205, SIMI VALLEY, CA 93063-6721
(855) 504-4544
(805) 577-2018
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A159035
CA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/08/2013
Last updated
08/26/2020
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