Provider Demographics
NPI:1962572909
Name:CHANBONPIN, ARACELI DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:ARACELI
Middle Name:DAVID
Last Name:CHANBONPIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1414
Mailing Address - Country:US
Mailing Address - Phone:626-285-5700
Mailing Address - Fax:
Practice Address - Street 1:225 E LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1414
Practice Address - Country:US
Practice Address - Phone:626-285-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A393800Medicaid
CA00A393800Medicaid