Provider Demographics
NPI:1841201449
Name:CHAO & TAN MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:CHAO & TAN MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIKANG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-255-3900
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92312-0626
Mailing Address - Country:US
Mailing Address - Phone:760-255-3900
Mailing Address - Fax:760-255-3980
Practice Address - Street 1:309 E MOUNTAIN VIEW ST
Practice Address - Street 2:SUITE 110
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2814
Practice Address - Country:US
Practice Address - Phone:760-255-3900
Practice Address - Fax:760-255-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA068769174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0094840Medicaid
CAGR0094840Medicaid