Provider Demographics
NPI:1285168104
Name:CHONG, WILLIAM (BCBA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:CHONG
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 RED HILL AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3418
Mailing Address - Country:US
Mailing Address - Phone:714-881-0427
Mailing Address - Fax:714-327-0673
Practice Address - Street 1:3125 RED HILL AVE
Practice Address - Street 2:STE 100
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3418
Practice Address - Country:US
Practice Address - Phone:714-881-0427
Practice Address - Fax:714-327-0673
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-25659103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst