Healthcare Provider Details

I. General information

NPI: 1376586933
Provider Name (Legal Business Name): YUN SUK CHONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 E CHAPMAN AVE SUITE 203
ORANGE CA
92866-2139
US

IV. Provider business mailing address

1110 E CHAPMAN AVE SUITE 203
ORANGE CA
92866-2139
US

V. Phone/Fax

Practice location:
  • Phone: 714-453-0688
  • Fax: 714-453-0689
Mailing address:
  • Phone: 714-453-0688
  • Fax: 714-453-0689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA73098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: