Individual provider Active NPI

Sarah Eunha Chong, D.D.S

  • General Practice Dentistry
  • Tustin, CA
National Provider Identifier
1174923262
Registry record updated Jul 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
63995 Issued in CA
Practice address
13721 Newport Ave
Tustin, CA 92780-4690
Phone
(714) 368-1400
NPI assigned
Aug 26, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 63995 CA Primary

Addresses

Primary practice location

13721 Newport Ave
Tustin, CA 92780-4690

Mailing address

13721 Newport Ave
Tustin, CA 92780-4690
Phone (714) 368-1400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
63995CAMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657670400000",
    "number": "1174923262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13721 NEWPORT AVE",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927804690",
            "telephone_number": "714-368-1400",
            "fax_number": "714-368-1411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13721 NEWPORT AVE",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927804690",
            "telephone_number": "714-368-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHONG",
        "first_name": "SARAH",
        "middle_name": "EUNHA",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-26",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "63995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.