Provider Demographics
NPI:1619118494
Name:CHIANG, BOB (MD)
Entity Type:Individual
Prefix:
First Name:BOB
Middle Name:
Last Name:CHIANG
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 1:7 WOODLYN LN
Mailing Address - Street 2:
Mailing Address - City:BRADBURY
Mailing Address - State:CA
Mailing Address - Zip Code:91008-1131
Mailing Address - Country:US
Mailing Address - Phone:626-818-9506
Mailing Address - Fax:626-775-4275
Practice Address - Street 1:7 WOODLYN LN
Practice Address - Street 2:
Practice Address - City:BRADBURY
Practice Address - State:CA
Practice Address - Zip Code:91008-1131
Practice Address - Country:US
Practice Address - Phone:626-818-9506
Practice Address - Fax:626-775-4275
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106244207QH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine