Healthcare Provider Details

I. General information

NPI: 1598381493
Provider Name (Legal Business Name): ELIZABETH Y CHONG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH CHO

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 IRVINE BLVD STE 102
IRVINE CA
92620-1960
US

IV. Provider business mailing address

638 MONTE VIS
IRVINE CA
92602-2014
US

V. Phone/Fax

Practice location:
  • Phone: 714-730-9580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34652
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: