Provider Demographics
NPI:1407889637
Name:COMPREHENSIVE CARDIOVASCULAR SPECIALISTS, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:COMPREHENSIVE CARDIOVASCULAR SPECIALISTS, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:K
Authorized Official - Last Name:FUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-281-8663
Mailing Address - Street 1:220 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3705
Mailing Address - Country:US
Mailing Address - Phone:626-281-8663
Mailing Address - Fax:626-281-6318
Practice Address - Street 1:220 S 1ST ST
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3705
Practice Address - Country:US
Practice Address - Phone:626-281-8663
Practice Address - Fax:626-281-6318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACH4605OtherMEDICARE RAILROAD
CAZZZ58519ZOtherBLUE SHIELD
CAGR0089890Medicaid
CAZZZ58519ZOtherBLUE SHIELD