Healthcare Provider Details

I. General information

NPI: 1487098802
Provider Name (Legal Business Name): MICHAEL TZYY-SHYAN CHUANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL TZYY SHYAN CHUANG DO

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CRAVEN RD
SAN MARCOS CA
92078-4201
US

IV. Provider business mailing address

400 CRAVEN RD
SAN MARCOS CA
92078-4201
US

V. Phone/Fax

Practice location:
  • Phone: 866-459-2912
  • Fax:
Mailing address:
  • Phone: 866-459-2912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number20A13562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: