Healthcare Provider Details

I. General information

NPI: 1801198429
Provider Name (Legal Business Name): FU LI CHAO MD A PROF MED CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 W LAS TUNAS DR
SAN GABRIEL CA
91776-1216
US

IV. Provider business mailing address

PO BOX 5486
ORANGE CA
92863-5486
US

V. Phone/Fax

Practice location:
  • Phone: 626-289-1266
  • Fax:
Mailing address:
  • Phone: 818-550-0900
  • Fax: 303-953-8260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA66989
License Number StateCA

VIII. Authorized Official

Name: FU LI CHAO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 909-985-2112