Healthcare Provider Details

I. General information

NPI: 1780071498
Provider Name (Legal Business Name): STEPHANIE KAY CHIAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 W EL CAMINO REAL STE 2
MOUNTAIN VIEW CA
94040-2461
US

IV. Provider business mailing address

4285 PAYNE AVE # 9827
SAN JOSE CA
95117-3324
US

V. Phone/Fax

Practice location:
  • Phone: 201-472-5029
  • Fax: 650-481-9470
Mailing address:
  • Phone: 201-472-5029
  • Fax: 650-481-9470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberA183070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: