Provider Demographics
NPI:1619049749
Name:HUNG, CHUANG TI (MD)
Entity Type:Individual
Prefix:DR
First Name:CHUANG
Middle Name:TI
Last Name:HUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 N 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4906
Mailing Address - Country:US
Mailing Address - Phone:909-985-2709
Mailing Address - Fax:909-985-3688
Practice Address - Street 1:629 N 13TH AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4906
Practice Address - Country:US
Practice Address - Phone:909-985-2709
Practice Address - Fax:909-985-3688
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA363360207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A363360Medicare PIN