Organization
KWANHO CHONG, M.D., A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KWANHO CHONG M.D. (PRESIDENT)
(805) 522-9018
Entity
Organization
Contact information
Practice address
1158 ROADRUNNER WAY, SIMI VALLEY, CA 93065-3158
(805) 522-9018
(951) 272-9924
Mailing address
1158 ROADRUNNER WAY, SIMI VALLEY, CA 93065-3158
(805) 522-9018
(951) 272-9924
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
Primary
G84968
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G849680
—
CA
01
—
G84968
CA MEDICAL LICENSE
CA
Enumeration date
11/11/2010
Last updated
02/27/2012
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