Provider Demographics
NPI:1477693414
Name:CHIANG, JUNE M (OD)
Entity Type:Individual
Prefix:DR
First Name:JUNE
Middle Name:M
Last Name:CHIANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 S HILL ST STE 365
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-2212
Mailing Address - Country:US
Mailing Address - Phone:213-749-3461
Mailing Address - Fax:213-749-1618
Practice Address - Street 1:1149 S HILL ST STE 365
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-2212
Practice Address - Country:US
Practice Address - Phone:213-749-3461
Practice Address - Fax:213-749-1618
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10230T152WC0802X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0102300Medicaid
CAOP10230-AMedicare ID - Type Unspecified