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General NPI Number Information
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NPI Number | 1992827653
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Entity Type | Individual
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Provider Name | CHRISTINE JANEL HAYWOOD BONG M.D., FAAP, M.P.H.
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Gender | Female
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2960 N CIRCLE DR STE 200
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-1163
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Country | US
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Telephone | 719-634-8891
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Fax |
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Provider Business Mailing Address
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Address Line | 7625 SLATE CT
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-2922
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Country | US
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Telephone | 719-313-3267
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Fax | 719-309-6847
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 47375
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | LL28136
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License Number State | SC
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