Provider Demographics
NPI:1932165263
Name:TO, STEPHEN YAN CHUN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:YAN CHUN
Last Name:TO
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 1:4503 BOWIE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-8326
Mailing Address - Country:US
Mailing Address - Phone:909-626-4814
Mailing Address - Fax:
Practice Address - Street 1:1798 N GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2918
Practice Address - Country:US
Practice Address - Phone:909-865-9532
Practice Address - Fax:909-397-0194
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG751062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G751060Medicaid
WG75106FMedicare ID - Type Unspecified
WG75106EMedicare ID - Type Unspecified
CAWG75106AMedicare ID - Type UnspecifiedUCLA
CA00G751060Medicaid