| Chona Badar Green M D A Professional Corporation | |
|
23121 Plaza Pointe Dr Ste 150 Laguna Hills CA 92653-1468 | |
| (949) 586-4113 | |
| (949) 837-5002 |
| Full Name | Chona Badar Green M D A Professional Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 23121 Plaza Pointe Dr Ste 150, Laguna Hills, California |
| Authorized Official Name and Position | Chona Badar Green (PRESIDENT) |
| Authorized Official Contact | 9495864113 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chona Badar Green M D A Professional Corporation 23121 Plaza Pointe Dr Ste 150 Laguna Hills CA 92653-1468 Ph: (949) 586-4113 | Chona Badar Green M D A Professional Corporation 23121 Plaza Pointe Dr Ste 150 Laguna Hills CA 92653-1468 Ph: (949) 586-4113 |
| NPI Number | 1518225002 |
|---|---|
| Provider Enumeration Date | 05/02/2012 |
| Last Update Date | 02/09/2024 |
| Certification Date | 02/09/2024 |
| Medicare PECOS PAC ID | 9234380361 |
|---|---|
| Medicare Enrollment ID | O20121119000104 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518225002 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | A53508 (California) | Primary |
| Provider Name | Chona B Green |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437219441 PECOS PAC ID: 0840441978 Enrollment ID: I20121119000145 |
| Provider Name | Ko G Liuo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841683406 PECOS PAC ID: 0042510695 Enrollment ID: I20151203001735 |
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