Provider Demographics
NPI:1588779227
Name:CHONG, LAVINIA K (MD FACS)
Entity type:Individual
Prefix:
First Name:LAVINIA
Middle Name:K
Last Name:CHONG
Suffix:
Gender:F
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 AVOCADO AVE
Mailing Address - Street 2:SUITE 803
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-644-1400
Mailing Address - Fax:949-644-5988
Practice Address - Street 1:1401 AVOCADO AVE
Practice Address - Street 2:SUITE 803
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-644-1400
Practice Address - Fax:949-644-5988
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG683712086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G32881Medicare UPIN
CAG68371Medicare ID - Type Unspecified