Provider Demographics
NPI:1528377314
Name:BEN CHIANG, M.D., INC.
Entity Type:Organization
Organization Name:BEN CHIANG, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:CHUN-JU
Authorized Official - Last Name:CHIANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-855-1091
Mailing Address - Street 1:3120 S HACIENDA BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6305
Mailing Address - Country:US
Mailing Address - Phone:626-855-1091
Mailing Address - Fax:626-369-5988
Practice Address - Street 1:3120 S HACIENDA BLVD STE 103
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6305
Practice Address - Country:US
Practice Address - Phone:626-855-1091
Practice Address - Fax:626-369-5988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty