MEDICARE: KIMBO B CHIA M. D., F . A . C. S.

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	208600000X	Surgery Physician	204877	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326159237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBO B CHIA M. D., F . A . C. S.

Provider Business Mailing Address
First Line	:	564 NIAGARA ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14201-1108
Country	:	US
Telephone Number	:	716-332-0678
Fax Number	:	716-332-0679

Provider Business Practice Location Address
First Line	:	564 NIAGARA ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14201-1108
Country	:	US
Telephone Number	:	716-332-0678
Fax Number	:	716-332-0679

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/31/2016

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