Healthcare Provider Details

I. General information

NPI: 1578476446
Provider Name (Legal Business Name): CHAE ANGELO JOHNSON II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 QUAIL ST STE 210
NEWPORT BEACH CA
92660-2710
US

IV. Provider business mailing address

3428 W 59TH PL
LOS ANGELES CA
90043-3010
US

V. Phone/Fax

Practice location:
  • Phone: 949-889-1368
  • Fax:
Mailing address:
  • Phone: 323-219-0365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: