Healthcare Provider Details

I. General information

NPI: 1134419443
Provider Name (Legal Business Name): ANTHONY RITCHIE CHUANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 MONTE VIS
IRVINE CA
92602
US

IV. Provider business mailing address

1368 MADERA WAY
MILLBRAE CA
94030-2825
US

V. Phone/Fax

Practice location:
  • Phone: 650-922-8261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA124018
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: