Provider Demographics
NPI:1104892710
Name:CHIANG, PENGTA ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:PENGTA
Middle Name:ANTHONY
Last Name:CHIANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5050 AVENIDA ENCINAS
Mailing Address - Street 2:STE 200
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-4381
Mailing Address - Country:US
Mailing Address - Phone:760-439-1963
Mailing Address - Fax:760-268-0931
Practice Address - Street 1:4002 VISTA WAY
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4506
Practice Address - Country:US
Practice Address - Phone:760-439-1963
Practice Address - Fax:760-268-0931
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA61358207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A613580Medicaid
CAI07546Medicare UPIN
CA00A613580Medicare PIN