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General NPI Number Information
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NPI Number | 1063842649
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Entity Type | Organization
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Legal Business Name | EDWARD TANGCHITNOB, MD., INC.
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Dates
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Enumeration Date | 11/19/2013
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Last Update Date | 08/08/2016
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Provider Practice Location Address
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Address Line | 1135 S. SUNSET AVE SUITE 102
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City | WEST COVINA
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State | CA
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Zip | 91790-3937
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Country | US
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Telephone | 626-338-5377
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Fax | 626-851-8822
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Provider Business Mailing Address
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Address Line | 1135 S SUNSET AVE SUITE 102
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City | WEST COVINA
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State | CA
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Zip | 91790-3937
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Country | US
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Telephone | 626-338-5377
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Fax | 626-851-8822
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWARD P. TANGCHITNOB
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Credential | M.D.
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Telephone | 626-338-5377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A110608
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License Number State | CA
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