Provider Demographics
NPI:1023402021
Name:R P CHAO RADIOLOGY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:R P CHAO RADIOLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-227-2727
Mailing Address - Street 1:707 S GARFIELD AVE
Mailing Address - Street 2:SUITE B-001
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5859
Mailing Address - Country:US
Mailing Address - Phone:626-227-2727
Mailing Address - Fax:626-227-2757
Practice Address - Street 1:707 S GARFIELD AVE
Practice Address - Street 2:SUITE B-001
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5859
Practice Address - Country:US
Practice Address - Phone:626-227-2727
Practice Address - Fax:626-227-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC2578418261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2897836Medicaid
CAW195267Medicare PIN