Provider Demographics
NPI:1386782167
Name:CHON, KEN B (MD)
Entity type:Individual
Prefix:DR
First Name:KEN
Middle Name:B
Last Name:CHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KYUNG
Other - Middle Name:B
Other - Last Name:CHON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8522 PAINTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-3335
Mailing Address - Country:US
Mailing Address - Phone:562-698-6266
Mailing Address - Fax:562-945-4530
Practice Address - Street 1:8522 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-3335
Practice Address - Country:US
Practice Address - Phone:562-698-6266
Practice Address - Fax:562-945-4530
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA389692080N0001X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1447398300OtherNPI GROUP #
CA1750463014OtherGROUP NPI
CAA38969OtherSTATE LICENSE
CAGR0102180OtherMEDI-CAL
CA202921026OtherTAX ID#