Provider Demographics
NPI:1588752349
Name:CHUANG, DICK (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:DICK
Middle Name:
Last Name:CHUANG
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4762
Mailing Address - Country:US
Mailing Address - Phone:626-289-5181
Mailing Address - Fax:626-289-2725
Practice Address - Street 1:1024 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4762
Practice Address - Country:US
Practice Address - Phone:626-289-5181
Practice Address - Fax:626-289-2725
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18202363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA18202AMedicare PIN
CAQ63058Medicare UPIN