Provider Demographics
NPI:1124258587
Name:JOYCE H. CHONG M.D. INC.
Entity type:Organization
Organization Name:JOYCE H. CHONG M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-773-1212
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50783305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C507830Medicaid
CAG13192OtherUPIN
CA11672399OtherCAQH