Provider Demographics
NPI:1316168792
Name:CHIANG, PETER C (M D)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:C
Last Name:CHIANG
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-2316
Mailing Address - Country:US
Mailing Address - Phone:818-502-2050
Mailing Address - Fax:818-241-3575
Practice Address - Street 1:600 S GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-2316
Practice Address - Country:US
Practice Address - Phone:818-502-2050
Practice Address - Fax:818-241-3575
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66194207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H31724Medicare UPIN