Individual provider Active NPI

Pamela Jong, M.D.

  • Internal Medicine Physician
  • San Diego, CA
National Provider Identifier
1114017423
Registry record updated Jul 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A65022 Issued in CA
Practice address
3350 La Jolla Village Dr
Mail Code 111-N
San Diego, CA 92161-0002
Phone
(858) 552-8585
Fax
(858) 642-6273
NPI assigned
Oct 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A65022 CA Primary

Addresses

Primary practice location

3350 La Jolla Village Dr
Mail Code 111-N
San Diego, CA 92161-0002

Mailing address

3350 La Jolla Village Dr
Mail Code 111-N
San Diego, CA 92161-0002
Phone (858) 552-8585

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130812000132 CA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 1658513254

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184284800000",
    "number": "1114017423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3350 LA JOLLA VILLAGE DR",
            "address_2": "MAIL CODE 111-N",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921610002",
            "telephone_number": "858-552-8585",
            "fax_number": "858-642-6273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 LA JOLLA VILLAGE DR",
            "address_2": "MAIL CODE 111-N",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921610002",
            "telephone_number": "858-552-8585",
            "fax_number": "858-642-6273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONG",
        "first_name": "PAMELA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-15",
        "last_updated": "2007-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A65022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.