Provider Demographics
NPI:1295834695
Name:DUMRONG TANGCHITNOB MD INC
Entity Type:Organization
Organization Name:DUMRONG TANGCHITNOB MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUMRONG
Authorized Official - Middle Name:
Authorized Official - Last Name:TANGCHITNOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-338-5377
Mailing Address - Street 1:1135 S SUNSET AVE
Mailing Address - Street 2:STE. #102
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3937
Mailing Address - Country:US
Mailing Address - Phone:626-338-5377
Mailing Address - Fax:626-851-8822
Practice Address - Street 1:1135 S SUNSET AVE
Practice Address - Street 2:STE. #102
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3937
Practice Address - Country:US
Practice Address - Phone:626-338-5377
Practice Address - Fax:626-851-8822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42027207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A420270Medicaid
CA00A420270Medicaid
CAF00191Medicare UPIN