Healthcare Provider Details

I. General information

NPI: 1902839160
Provider Name (Legal Business Name): CHIA-YU TENG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18575 GALE AVE STE 235
CITY OF INDUSTRY CA
91748-1383
US

IV. Provider business mailing address

18575 GALE AVE STE 235
CITY OF INDUSTRY CA
91748-1383
US

V. Phone/Fax

Practice location:
  • Phone: 626-810-7708
  • Fax: 626-810-7002
Mailing address:
  • Phone: 626-810-7708
  • Fax: 626-810-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG69120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: