Provider Demographics
NPI:1174609614
Name:DENG, MARIO CHIH-HSIUNG KARL (MD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:CHIH-HSIUNG KARL
Last Name:DENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10833 LE CONTE AVE
Mailing Address - Street 2:A2-237 CHS
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-3075
Mailing Address - Country:US
Mailing Address - Phone:310-825-5158
Mailing Address - Fax:310-206-9133
Practice Address - Street 1:200 MEDICAL PLAZA DRIVEWAY
Practice Address - Street 2:STE. 365C
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-794-2727
Practice Address - Fax:310-794-0011
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2012-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY218687207R00000X
CAF5704207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02097529Medicaid
CA1174609614Medicaid
CAFW697ZMedicare PIN
NYH24934Medicare UPIN
CA1174609614Medicaid