Healthcare Provider Details

I. General information

NPI: 1043389471
Provider Name (Legal Business Name): CHANG-ZERN C HONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S BLDG 53. ROOM B17
ORANGE CA
92868-3201
US

IV. Provider business mailing address

4 WARMSPRING
IRVINE CA
92614-5422
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-6672
  • Fax: 714-456-6557
Mailing address:
  • Phone: 949-786-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA37867
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: