Provider Demographics
NPI:1275089070
Name:VANG, CHIA
Entity Type:Individual
Prefix:
First Name:CHIA
Middle Name:
Last Name:VANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8338 WEST LN STE 105
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3145
Mailing Address - Country:US
Mailing Address - Phone:209-466-0721
Mailing Address - Fax:209-466-6567
Practice Address - Street 1:8338 WEST LN STE 105
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3145
Practice Address - Country:US
Practice Address - Phone:209-466-0721
Practice Address - Fax:209-466-6567
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist