Healthcare Provider Details

I. General information

NPI: 1457314262
Provider Name (Legal Business Name): MALCOLM S POND MD INC & CHIAYU CHEN MD PTR CARDIOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 BROCKTON AVE STE 203
RIVERSIDE CA
92501-4006
US

IV. Provider business mailing address

4500 BROCKTON AVE STE 203
RIVERSIDE CA
92501-4006
US

V. Phone/Fax

Practice location:
  • Phone: 951-686-3600
  • Fax: 951-686-1162
Mailing address:
  • Phone: 951-686-3600
  • Fax: 951-686-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: CHIAYU CHEN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 951-686-3600