MEDICARE: HUNTINGTON GERIATRIC MEDICAL GROUP

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	A062136	CA

General Provider Information

NPI Number	:	1265627277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNTINGTON GERIATRIC MEDICAL GROUP

Provider Business Mailing Address
First Line	:	2100 E COLORADO BLVD
Second Line	:	SUITE 1
City	:	PASADENA
State	:	CA
Zip	:	91107-3545
Country	:	US
Telephone Number	:	626-229-9865
Fax Number	:	626-229-9867

Provider Business Practice Location Address
First Line	:	2100 E COLORADO BLVD
Second Line	:	SUITE 1
City	:	PASADENA
State	:	CA
Zip	:	91107-3545
Country	:	US
Telephone Number	:	626-229-9865
Fax Number	:	626-229-9867

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NORMAN TIEN-YO CHIEN
Credential	:	MD
Telephone Number	:	626-229-9865

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	06/23/2016

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