Healthcare Provider Details

I. General information

NPI: 1861530511
Provider Name (Legal Business Name): CHUA CHUANG INC. A MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 W BEVERLY BLVD
MONTEBELLO CA
90640-2216
US

IV. Provider business mailing address

3111 W. BEVERLY BLVD.
MONTEBELLO CA
90640
US

V. Phone/Fax

Practice location:
  • Phone: 323-728-0671
  • Fax: 323-728-8355
Mailing address:
  • Phone: 323-728-0671
  • Fax: 323-728-8355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA34309
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA34309
License Number StateCA

VIII. Authorized Official

Name: WILLIAM A CHUA SR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 323-728-0671