Provider Demographics
NPI:1376586933
Name:CHONG, YUN SUK (MD)
Entity Type:Individual
Prefix:DR
First Name:YUN
Middle Name:SUK
Last Name:CHONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1110 E CHAPMAN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2139
Mailing Address - Country:US
Mailing Address - Phone:714-453-0688
Mailing Address - Fax:714-453-0689
Practice Address - Street 1:1110 E CHAPMAN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2139
Practice Address - Country:US
Practice Address - Phone:714-453-0688
Practice Address - Fax:714-453-0689
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA730982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A730980Medicaid
CA7734898OtherAETNA BH PIN #
CA393879OtherMGD HEALTH NETWORK PIN
CAWA73098DMedicare ID - Type UnspecifiedMEDICARE PPIN
CA00A730980Medicaid