Healthcare Provider Details

I. General information

NPI: 1205279106
Provider Name (Legal Business Name): KUANG-CHUNG HU CHIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9445 LA JOLLA FARMS RD
LA JOLLA CA
92037-1128
US

IV. Provider business mailing address

9445 LA JOLLA FARMS RD
LA JOLLA CA
92037-1128
US

V. Phone/Fax

Practice location:
  • Phone: 858-622-0888
  • Fax:
Mailing address:
  • Phone: 858-622-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA50354
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA5035A
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: