Provider Demographics
NPI:1336189117
Name:AN PANG CHIENG MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:AN PANG CHIENG MD A PROFESSIONAL CORPORATION
Other - Org Name:EL SERENO MEDICAL GROUP INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AN PANG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-225-2351
Mailing Address - Street 1:3301 N EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-1931
Mailing Address - Country:US
Mailing Address - Phone:323-225-2351
Mailing Address - Fax:323-225-7555
Practice Address - Street 1:3301 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-1931
Practice Address - Country:US
Practice Address - Phone:323-225-2351
Practice Address - Fax:323-225-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8055207Q00000X
CAG66648207R00000X
CAA48048208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX80550Medicaid
CA00A480480Medicaid
CA00G666480Medicaid
CAI00308Medicare UPIN
CA00A480480Medicaid
CAE47712Medicare UPIN
CAW20A8055BMedicare ID - Type UnspecifiedDR. JAMES N. WANG
CAWA48048CMedicare ID - Type UnspecifiedDR. WEI-DER SHOW
CAWG66648AMedicare ID - Type UnspecifiedDR. AN PANG CHIENG