Provider Demographics
NPI:1457314262
Name:MALCOLM S POND MD INC & CHIAYU CHEN MD PTR CARDIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:MALCOLM S POND MD INC & CHIAYU CHEN MD PTR CARDIOLOGY ASSOCIATES
Other - Org Name:RIVERSIDE CARDIOLOGY ASSOCIATES MED. GRP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIAYU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-686-3600
Mailing Address - Street 1:4500 BROCKTON AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-4006
Mailing Address - Country:US
Mailing Address - Phone:951-686-3600
Mailing Address - Fax:951-686-1162
Practice Address - Street 1:4500 BROCKTON AVE STE 203
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4006
Practice Address - Country:US
Practice Address - Phone:951-686-3600
Practice Address - Fax:951-686-1162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0057770Medicaid
CACP4058OtherRAILROAD MEDICARE
CACP4058OtherRAILROAD MEDICARE