Individual provider Active NPI

Ray Anne Chung, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Mission Viejo, CA
National Provider Identifier
1255019030
Registry record updated Sep 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
2027752 Issued in CA
Practice address
27700 Medical Center Rd
Mission Viejo, CA 92691-6426
Phone
(562) 298-3886
NPI assigned
Jul 11, 2023
Last updated
Sep 15, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 2027752 CA Primary

Addresses

Primary practice location

27700 Medical Center Rd
Mission Viejo, CA 92691-6426

Mailing address

236 W Rosslynn Ave
Fullerton, CA 92832-2339
Phone (562) 298-3886

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231128003115 CA Practitioner - Nurse Practitioner 8022466283 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2027752CAMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Oc Trauma Inc CurrentSince Sep 30, 2023 Accepting new patients

Locations

27700 Medical Center Rd
Mission Viejo, CA 92691
Phone (949) 364-7744

27799 Medical Center Rd
Ste 440
Mission Viejo, CA 92691
Phone (949) 364-1007

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1689033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694736000000",
    "number": "1255019030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "236 W ROSSLYNN AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928322339",
            "telephone_number": "562-298-3886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27700 MEDICAL CENTER RD",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916426",
            "telephone_number": "562-298-3886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "RAY ANNE",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-11",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "2027752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mission Viejo, CA

Sources for this page

Verify at the official NPI Registry.