Provider Demographics
NPI:1285697227
Name:CHIANG, GLENN (MD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:CHIANG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:705 W LA VETA AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4447
Mailing Address - Country:US
Mailing Address - Phone:714-639-4901
Mailing Address - Fax:714-771-5389
Practice Address - Street 1:520 SUPERIOR AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3637
Practice Address - Country:US
Practice Address - Phone:949-631-9215
Practice Address - Fax:949-631-4576
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2019-02-22
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Provider Licenses
StateLicense IDTaxonomies
CAG80417207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G67077Medicare UPIN