Provider Demographics
NPI:1598976680
Name:CHUANG, SHANG-TIAN (DO)
Entity Type:Individual
Prefix:
First Name:SHANG-TIAN
Middle Name:
Last Name:CHUANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-2526
Mailing Address - Country:US
Mailing Address - Phone:323-260-4184
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:4060 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-2526
Practice Address - Country:US
Practice Address - Phone:323-260-4184
Practice Address - Fax:419-866-5453
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10083207ZP0102X
CA20A8851207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278580300Medicaid
FL78214OtherBCBS
FL278580300Medicaid
FLP00415205Medicare PIN