Healthcare Provider Details

I. General information

NPI: 1861272858
Provider Name (Legal Business Name): CATHLEEN SHEN CHONG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18102 CULVER DR
IRVINE CA
92612-2730
US

IV. Provider business mailing address

18102 CULVER DR
IRVINE CA
92612-2730
US

V. Phone/Fax

Practice location:
  • Phone: 951-800-8095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number109509
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number109509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: