Provider Demographics
NPI:1134482177
Name:LAVINIA K. CHONG, M.D., INC.
Entity Type:Organization
Organization Name:LAVINIA K. CHONG, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAVINIA
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:CHONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-644-1400
Mailing Address - Street 1:1401 AVOCADO AVE
Mailing Address - Street 2:SUITE 803
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7720
Mailing Address - Country:US
Mailing Address - Phone:949-644-1400
Mailing Address - Fax:949-644-5988
Practice Address - Street 1:1401 AVOCADO AVE
Practice Address - Street 2:SUITE 803
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7720
Practice Address - Country:US
Practice Address - Phone:949-644-1400
Practice Address - Fax:949-644-5988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68371261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1588779227OtherMEDICARE (INDIVIDUAL) NPI
CAG68371OtherPTAN
CAG68371OtherPTAN