Healthcare Provider Details

I. General information

NPI: 1982762993
Provider Name (Legal Business Name): WALTER WAI-TAK CHIEN MD, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 COFFEE ROAD
MODESTO CA
95355-2405
US

IV. Provider business mailing address

2013 COFFEE ROAD
MODESTO CA
95355-2405
US

V. Phone/Fax

Practice location:
  • Phone: 209-529-0758
  • Fax: 209-529-8524
Mailing address:
  • Phone: 209-529-0758
  • Fax: 209-529-8524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberG56242
License Number StateCA

VIII. Authorized Official

Name: WALTER WAI-TAK CHIEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 209-529-0758