Provider Demographics
NPI:1841380490
Name:CHAO, LIKANG (MD)
Entity Type:Individual
Prefix:DR
First Name:LIKANG
Middle Name:
Last Name:CHAO
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: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:769-255-3900
Mailing Address - Fax:760-255-3980
Practice Address - Street 1:309 E MOUNTAIN VIEW ST
Practice Address - Street 2:#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
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85087174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist