MEDICARE: GEORGE J. CHIANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2088P0231X	Pediatric Urology Physician	M-17903	ID
2	208800000X	Urology Physician	A98687	CA
3	2088P0231X	Pediatric Urology Physician	A98687	CA

General Provider Information

NPI Number	:	1093773954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE J. CHIANG M.D.

Provider Business Mailing Address
First Line	:	3860 CALLE FORTUNADA
Second Line	:	STE #210
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4802
Country	:	US
Telephone Number	:	858-309-6303
Fax Number	:

Provider Business Practice Location Address
First Line	:	7920 FROST ST
Second Line	:	STE 200
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2736
Country	:	US
Telephone Number	:	858-279-8527
Fax Number	:	858-966-8479

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	02/10/2025

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