Healthcare Provider Details

I. General information

NPI: 1952838518
Provider Name (Legal Business Name): CHRISTINE CHUNG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 07/11/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOAG DR
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

1 HOAG DRIVE BLDG 41, STE 301/302
NEWPORT BEACH CA
92663-2115
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-6665
  • Fax:
Mailing address:
  • Phone: 949-764-6665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number61219192
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20A22942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: