1194756551 NPI number — DR. CHARLES JUNG CHAO KWANG D.C.

Table of content: (NPI 1053464644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194756551 NPI number — DR. CHARLES JUNG CHAO KWANG D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KWANG
Provider First Name:
CHARLES
Provider Middle Name:
JUNG CHAO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194756551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 883
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEREY PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91754-0883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-786-7704
Provider Business Mailing Address Fax Number:
626-810-0113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 N 1ST AVE
Provider Second Line Business Practice Location Address:
204
Provider Business Practice Location Address City Name:
ARCADIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91006-3207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-786-7704
Provider Business Practice Location Address Fax Number:
626-810-0113
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC28111 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DC0281110 . This is a "MEDICAL NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DC0281110 . This is a "BLUESHIELD NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DC28111 . This is a "PPO NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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