Provider Demographics
NPI:1720199326
Name:CHUNG-WATANABE, ESTHER J (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ESTHER
Middle Name:J
Last Name:CHUNG-WATANABE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17752 BEACH BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6838
Mailing Address - Country:US
Mailing Address - Phone:714-841-1040
Mailing Address - Fax:
Practice Address - Street 1:17752 BEACH BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6838
Practice Address - Country:US
Practice Address - Phone:714-841-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13019363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS42959Medicare UPIN