=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083649537
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHANDER MEDICAL ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 01/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9844 ATLANTIC AVE SUITE #A
-----------------------------------------------------
City | SOUTH GATE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90280-5219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-631-3502
-----------------------------------------------------
Fax | 310-631-5143
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3547
-----------------------------------------------------
City | CERRITOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90703-3547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-631-3502
-----------------------------------------------------
Fax | 310-631-5143
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WEN-YUAN MARIEANNE CHIANG
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 310-493-8505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 20A8521
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 20A8521
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------