MEDICARE: CHUA CHUANG INC. A MEDICAL

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	207RH0003X	Hematology & Oncology Physician	A34309	CA
2	207R00000X	Internal Medicine Physician	A34309	CA

General Provider Information

NPI Number	:	1861530511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHUA CHUANG INC. A MEDICAL

Provider Business Mailing Address
First Line	:	3111 W. BEVERLY BLVD.
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640
Country	:	US
Telephone Number	:	323-728-0671
Fax Number	:	323-728-8355

Provider Business Practice Location Address
First Line	:	3111 W BEVERLY BLVD
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-2216
Country	:	US
Telephone Number	:	323-728-0671
Fax Number	:	323-728-8355

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM A CHUA SR.
Credential	:	M.D.
Telephone Number	:	323-728-0671

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/09/2012

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