Healthcare Provider Details

I. General information

NPI: 1023015336
Provider Name (Legal Business Name): SOPHIA C CHIANG D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8438 E SHEA BLVD SUITE 100
SCOTTSDALE AZ
85260-6669
US

IV. Provider business mailing address

15624 N 11TH ST
PHOENIX AZ
85022-3526
US

V. Phone/Fax

Practice location:
  • Phone: 480-661-7745
  • Fax: 480-661-5216
Mailing address:
  • Phone: 602-942-9722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberAZ4129
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: