Provider Demographics
NPI:1356528566
Name:TIENG, ANDREA S (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:S
Last Name:TIENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 FOOTHILL BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7695
Mailing Address - Country:US
Mailing Address - Phone:909-255-7200
Mailing Address - Fax:909-255-7215
Practice Address - Street 1:10801 FOOTHILL BLVD STE 106
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7695
Practice Address - Country:US
Practice Address - Phone:909-255-7200
Practice Address - Fax:909-255-7215
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241597207RG0100X
CAA106477207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY241597OtherMEDICAL LICENSE
CAA106477OtherMEDICAL LICENSE