Provider Demographics
NPI:1386820603
Name:HLA M. MAUNG M.D. INC.
Entity type:Organization
Organization Name:HLA M. MAUNG M.D. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:UY
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-949-8866
Mailing Address - Street 1:299 W FOOTHILL BLVD
Mailing Address - Street 2:STE 212
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3804
Mailing Address - Country:US
Mailing Address - Phone:909-949-8866
Mailing Address - Fax:909-385-0379
Practice Address - Street 1:7540 GARVEY AVE
Practice Address - Street 2:STE C
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2960
Practice Address - Country:US
Practice Address - Phone:909-949-8866
Practice Address - Fax:909-385-0379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55844207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A558440Medicare PIN
CAH08329Medicare UPIN