Healthcare Provider Details

I. General information

NPI: 1831014943
Provider Name (Legal Business Name): CHRISTOPHER JUNE WONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17772 IRVINE BLVD
TUSTIN CA
92780-3256
US

IV. Provider business mailing address

133 N DOMMER AVE
WALNUT CA
91789-2312
US

V. Phone/Fax

Practice location:
  • Phone: 909-784-5641
  • Fax:
Mailing address:
  • Phone: 626-678-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: