MEDICARE: PETER C. CHI, MEDICAL CORPORATION

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	207Q00000X	Family Medicine Physician	G77088	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F72123	OTHER	CA	UPIN

General Provider Information

NPI Number	:	1912135567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER C. CHI, MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	5828 TEMPLE CITY BLVD
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-2112
Country	:	US
Telephone Number	:	626-285-1154
Fax Number	:	626-285-1361

Provider Business Practice Location Address
First Line	:	5828 TEMPLE CITY BLVD
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-2112
Country	:	US
Telephone Number	:	626-285-1154
Fax Number	:	626-285-1361

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PETER C CHI
Credential	:	M.D.
Telephone Number	:	626-285-1154

Provider Enumeration Date	:	06/22/2009
Last Update Date	:	02/11/2011

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