Provider Demographics
NPI:1982656203
Name:CHONG, WOOK-CHIN (MD)
Entity Type:Individual
Prefix:
First Name:WOOK-CHIN
Middle Name:
Last Name:CHONG
Suffix:
Gender:M
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:P.O. BOX 3148
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-6217
Mailing Address - Country:US
Mailing Address - Phone:949-263-8620
Mailing Address - Fax:949-263-0473
Practice Address - Street 1:168 N BRENT ST
Practice Address - Street 2:402
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2817
Practice Address - Country:US
Practice Address - Phone:888-234-0004
Practice Address - Fax:805-641-3965
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC507892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C507890Medicaid
CA00C507890OtherBLUE SHIELD OF CA
CA00C507890OtherBLUE SHIELD OF CA
CAB52057Medicare UPIN
CA00C507890Medicaid