MEDICARE: CHIA VANG

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1275089070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIA VANG

Provider Business Mailing Address
First Line	:	8338 WEST LN STE 105
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95210-3145
Country	:	US
Telephone Number	:	209-466-0721
Fax Number	:	209-466-6567

Provider Business Practice Location Address
First Line	:	8338 WEST LN STE 105
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95210-3145
Country	:	US
Telephone Number	:	209-466-0721
Fax Number	:	209-466-6567

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

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	08/31/2016

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Directions to “ CHIA VANG ” Practice Location

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