Healthcare Provider Details

I. General information

NPI: 1003626276
Provider Name (Legal Business Name): CUA, GAN AND BIEN MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 W MERCED AVE STE 114
WEST COVINA CA
91790-3402
US

IV. Provider business mailing address

1433 W MERCED AVE STE 114
WEST COVINA CA
91790-3402
US

V. Phone/Fax

Practice location:
  • Phone: 626-960-4989
  • Fax:
Mailing address:
  • Phone: 626-960-4989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ZAHRA RAHIM UNWALLA
Title or Position: CREDENTIALING COORDINATOR
Credential: MS
Phone: 909-267-8540