Individual provider Active NPI

Chivano Chhieng, M.D.

  • Family Medicine Physician
  • San Diego, CA
National Provider Identifier
1336207505
Registry record updated Jun 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A71847 Issued in CA
Practice address
300 Fir St
San Diego, CA 92101-2327
Phone
(619) 499-2777
Fax
(619) 557-2770
NPI assigned
Dec 4, 2006
Last updated
Jun 17, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A71847 CA Primary

Addresses

Primary practice location

300 Fir St
San Diego, CA 92101-2327

Mailing address

300 Fir St
San Diego, CA 92101-2327
Phone (619) 499-2777

Other identifiers 1

IdentifierTypeStateIssuer
P161722OtherCAKAISER PERMANENTE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GU
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190424000989 GU Practitioner - Family Practice 0749253060 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
88.81 of 100Reported as group
Quality
83.57
Improvement activities
40
Cost
76.16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A71847CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Guam Memorial Hospital CurrentSince Mar 24, 2020 Accepting new patients
Guam Memorial Hospital CurrentSince Mar 24, 2020 Accepting new patients

Locations

850 Gov Carlos G Camacho Rd
#R
Tamuning, GU 96913
Phone (671) 647-2552

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371427200000",
    "number": "1336207505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 FIR ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012327",
            "telephone_number": "619-499-2777",
            "fax_number": "619-557-2770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 FIR ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012327",
            "telephone_number": "619-499-2777",
            "fax_number": "619-557-2770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHHIENG",
        "first_name": "CHIVANO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-04",
        "last_updated": "2013-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A71847",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER PERMANENTE",
            "identifier": "P161722",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.