Provider Demographics
NPI:1144356114
Name:PETER L. CHI, MD INC
Entity type:Organization
Organization Name:PETER L. CHI, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-834-8697
Mailing Address - Street 1:1770 N TRACY BLVD
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-2431
Mailing Address - Country:US
Mailing Address - Phone:209-834-8697
Mailing Address - Fax:209-830-9390
Practice Address - Street 1:1770 N TRACY BLVD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-2431
Practice Address - Country:US
Practice Address - Phone:209-834-8697
Practice Address - Fax:209-830-9390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53856174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A538560Medicaid
CA040013402OtherRR MEDICARE
CA038404OtherHILLS PHYSICIAN
CA00A538560Medicaid
CAZZZ04877ZMedicare PIN