Kwanho Chong, M.D., a Medical Corporation

Primary specialty

Surgical Critical Care PhysicianTaxonomy code 2086S0102X

License

G84968 Issued in CA

Legal business name

KWANHO CHONG, M.D., A MEDICAL CORPORATION

Practice address

1158 Roadrunner Way
Simi Valley, CA 93065-3158

Phone

(805) 522-9018

Fax

(951) 272-9924

NPI assigned

Nov 11, 2010

Last updated

Feb 27, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kwanho Chong, M.D.

Title

President

Phone

(805) 522-9018

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1289433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330300800000",
    "number": "1932400686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1158 ROADRUNNER WAY",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930653158",
            "telephone_number": "805-522-9018",
            "fax_number": "951-272-9924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1158 ROADRUNNER WAY",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930653158",
            "telephone_number": "805-522-9018",
            "fax_number": "951-272-9924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KWANHO CHONG, M.D., A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-11",
        "last_updated": "2012-02-27",
        "status": "A",
        "authorized_official_last_name": "CHONG",
        "authorized_official_first_name": "KWANHO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-522-9018",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "CA",
            "license": "G84968",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA MEDICAL LICENSE",
            "identifier": "G84968",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G849680",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• L&T Non Emergency Transportation

• Surgical Critical Care Physician in Simi Valley, CA
• Providers in Simi Valley, CA by specialty
• Surgical Critical Care Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2012; 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.