Provider Demographics
NPI:1427231802
Name:CHUONG, EDWIN T (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:T
Last Name:CHUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1540 BRIDGEGATE DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3912
Mailing Address - Country:US
Mailing Address - Phone:626-388-2319
Mailing Address - Fax:626-388-2341
Practice Address - Street 1:1540 BRIDGEGATE DR
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3912
Practice Address - Country:US
Practice Address - Phone:626-388-2319
Practice Address - Fax:626-388-2341
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-09
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA85751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine