MEDICARE: DR. CRISPINA H. CHONG-HAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	A89706	CA

General Provider Information

NPI Number	:	1205813953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRISPINA H. CHONG-HAN M.D.

Provider Business Mailing Address
First Line	:	208 W BORROMEO AVE
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-2207
Country	:	US
Telephone Number	:	714-993-9020
Fax Number	:

Provider Business Practice Location Address
First Line	:	441 N LAKEVIEW AVE
Second Line	:	KAISER PERMANENTE
City	:	ANAHEIM
State	:	CA
Zip	:	92807-3028
Country	:	US
Telephone Number	:	714-279-5129
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	12/08/2021

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