Basic Information
Provider Information
NPI: 1487678512
EntityType: 2
ReplacementNPI:  
OrganizationName: ADVANCED ANESTHESIA CONSULTANT INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 225 S LAKE AVE
Address2: 535
City: PASADENA
State: CA
PostalCode: 911013005
CountryCode: US
TelephoneNumber: 6267956596
FaxNumber: 6267958247
Practice Location
Address1: 438 W LAS TUNAS DR
Address2:  
City: SAN GABRIEL
State: CA
PostalCode: 917761216
CountryCode: US
TelephoneNumber: 6262895454
FaxNumber: 6264577172
Other Information
ProviderEnumerationDate: 07/26/2006
LastUpdateDate: 10/29/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: CHU
AuthorizedOfficialFirstName: CHENG
AuthorizedOfficialMiddleName: YUAN
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 6267956596
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X CAY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

ID Information
IDTypeStateIssuerDescription
ZZZ13136Z01CABLUE SHIELDOTHER
00A77705005CA MEDICAID


Home