Provider Demographics
NPI:1295753655
Name:CHIANG, WEN-YUAN MARIEANNE (DO)
Entity type:Individual
Prefix:DR
First Name:WEN-YUAN
Middle Name:MARIEANNE
Last Name:CHIANG
Suffix:
Gender:F
Credentials:DO
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 3547
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-3547
Mailing Address - Country:US
Mailing Address - Phone:310-631-3502
Mailing Address - Fax:310-631-5143
Practice Address - Street 1:9844 ATLANTIC AVE
Practice Address - Street 2:SUITE #A
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-5219
Practice Address - Country:US
Practice Address - Phone:310-631-3502
Practice Address - Fax:310-631-5143
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8521207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine