Provider Demographics
NPI:1922036052
Name:CHONG, CHARNG FA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARNG
Middle Name:FA
Last Name:CHONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:F
Other - Last Name:CHONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1801 W ROMNEYA DR
Mailing Address - Street 2:STE 501
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1830
Mailing Address - Country:US
Mailing Address - Phone:714-778-0454
Mailing Address - Fax:714-991-6103
Practice Address - Street 1:1801 W ROMNEYA DR
Practice Address - Street 2:SUITE 501
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1830
Practice Address - Country:US
Practice Address - Phone:714-778-0454
Practice Address - Fax:714-991-6103
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36211207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A362110Medicaid
CAA36211Medicare PIN
CAA84863Medicare UPIN
CAA36211AMedicare PIN