Provider Demographics
NPI:1437219441
Name:GREEN, CHONA BADAR (MD)
Entity Type:Individual
Prefix:MRS
First Name:CHONA
Middle Name:BADAR
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23121 PLAZA POINTE DR
Mailing Address - Street 2:#150
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-586-4113
Mailing Address - Fax:949-837-5002
Practice Address - Street 1:23121 PLAZA POINTE DR
Practice Address - Street 2:#150
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-586-4113
Practice Address - Fax:949-837-5002
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA535082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A53508Medicare ID - Type Unspecified
F94183Medicare UPIN