Provider Demographics
NPI:1508881939
Name:CHUANG, JESSE JEN-CHIEH (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:JEN-CHIEH
Last Name:CHUANG
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 989
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91802-0989
Mailing Address - Country:US
Mailing Address - Phone:626-427-1490
Mailing Address - Fax:
Practice Address - Street 1:207 S SANTA ANITA STREET STE G18
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1147
Practice Address - Country:US
Practice Address - Phone:626-427-1490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93456207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BM108WOtherMEDICARE PTAN
CAA93456OtherMEDICAL BOARD CERTIFICATE