MEDICARE: MUTHUSAMY MUTHIAH MD

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	207R00000X	Internal Medicine Physician	A51517	CA
2	207RC0000X	Cardiovascular Disease Physician	A51517	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679541148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUTHUSAMY MUTHIAH MD

Provider Business Mailing Address
First Line	:	840 TOWNE CENTER DR
Second Line	:	CHAPARRAL MEDICAL GROUP
City	:	POMONA
State	:	CA
Zip	:	91767-5900
Country	:	US
Telephone Number	:	909-398-1550
Fax Number	:	909-398-1488

Provider Business Practice Location Address
First Line	:	1866 N ORANGE GROVE AVE
Second Line	:	SUITE 202
City	:	POMONA
State	:	CA
Zip	:	91767-3031
Country	:	US
Telephone Number	:	909-623-8796
Fax Number	:	909-623-3076

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	05/03/2021

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