Healthcare Provider Details

I. General information

NPI: 1841953924
Provider Name (Legal Business Name): HALEY CAITLYN KONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23228 MADERO
MISSION VIEJO CA
92691-2706
US

IV. Provider business mailing address

23228 MADERO
MISSION VIEJO CA
92691-2706
US

V. Phone/Fax

Practice location:
  • Phone: 949-454-3940
  • Fax:
Mailing address:
  • Phone: 949-454-3940
  • Fax: 949-770-1953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: