Provider Demographics
NPI:1891835898
Name:HEMET CARDIOTHORACIC AND VASCULAR SURGERY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:HEMET CARDIOTHORACIC AND VASCULAR SURGERY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KUAN-CHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-925-0468
Mailing Address - Street 1:1000 E LATHAM AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4409
Mailing Address - Country:US
Mailing Address - Phone:951-925-0468
Mailing Address - Fax:951-658-9250
Practice Address - Street 1:1000 E LATHAM AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4409
Practice Address - Country:US
Practice Address - Phone:951-925-0468
Practice Address - Fax:951-658-9250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30566208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ12616ZMedicare ID - Type Unspecified