Provider Demographics
NPI:1821024282
Name:CHONG, JOYCE HAEKYOUNG (MD)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:HAEKYOUNG
Last Name:CHONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HAEKYOUNG
Other - Middle Name:JOYCE
Other - Last Name:CHONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:125 N EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1618
Mailing Address - Country:US
Mailing Address - Phone:714-773-1212
Mailing Address - Fax:714-773-9900
Practice Address - Street 1:125 N EUCLID ST
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1618
Practice Address - Country:US
Practice Address - Phone:714-773-1212
Practice Address - Fax:714-773-9900
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS25898208000000X
CAC50783208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100177710AMedicaid
KS12149507OtherMULTIPLAN
KS4310OtherPHS
KS100667OtherHPK
KS16943OtherCOVENTRY
KS040125OtherBCBS
KS4310OtherPHS
KS040125OtherBCBS