Healthcare Provider Details

I. General information

NPI: 1407102031
Provider Name (Legal Business Name): AGNES CHIANG JEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W HUNTINGTON DR STE 320
ARCADIA CA
91007-1500
US

IV. Provider business mailing address

133 N ALTADENA DR FL 2
PASADENA CA
91107-7325
US

V. Phone/Fax

Practice location:
  • Phone: 626-447-3516
  • Fax: 626-447-8546
Mailing address:
  • Phone: 626-397-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA120459
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: