Healthcare Provider Details

I. General information

NPI: 1376128124
Provider Name (Legal Business Name): BOB CHIANG MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 WOODLYN LN
BRADBURY CA
91008-1131
US

IV. Provider business mailing address

7 WOODLYN LN
BRADBURY CA
91008-1131
US

V. Phone/Fax

Practice location:
  • Phone: 626-818-9506
  • Fax: 626-775-4275
Mailing address:
  • Phone: 626-818-9506
  • Fax: 626-775-4275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: BOB CHIANG
Title or Position: PRESIDENT
Credential: MD
Phone: 626-818-9506