MEDICARE: PETER C CHI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G77088	CA

General Provider Information

NPI Number	:	1023090867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER C CHI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1916
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-7916
Country	:	US
Telephone Number	:	626-285-1154
Fax Number	:	626-285-1361

Provider Business Practice Location Address
First Line	:	5828 TEMPLE CITY BLVD
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-2112
Country	:	US
Telephone Number	:	626-285-1154
Fax Number	:	626-285-1361

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	10/04/2011

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