Healthcare Provider Details

I. General information

NPI: 1568463263
Provider Name (Legal Business Name): CHENGGANG HU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E VALLEY PKWY
ESCONDIDO CA
92025-3048
US

IV. Provider business mailing address

16955 VIA DEL CAMPO STE 215
SAN DIEGO CA
92127
US

V. Phone/Fax

Practice location:
  • Phone: 760-739-3000
  • Fax:
Mailing address:
  • Phone: 858-673-6100
  • Fax: 858-673-6113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA82247
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101283698
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: