MEDICARE: PETERSON JAMES CHAO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	061721-01	NY

General Provider Information

NPI Number	:	1316583032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETERSON JAMES CHAO DDS

Provider Business Mailing Address
First Line	:	5014 48TH ST
Second Line	:
City	:	WOODSIDE
State	:	NY
Zip	:	11377-7332
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2940 FRANCIS LEWIS BLVD
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-1536
Country	:	US
Telephone Number	:	347-438-1177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2019
Last Update Date	:	03/20/2026

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