Healthcare Provider Details

I. General information

NPI: 1265422893
Provider Name (Legal Business Name): NANLIN CHIANG DMD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2398 FAIR OAKS BLVD SUITE #1A
SACRAMENTO CA
95825
US

IV. Provider business mailing address

2398 FAIR OAKS BLVD SUITE #1A
SACRAMENTO CA
95825
US

V. Phone/Fax

Practice location:
  • Phone: 916-283-8818
  • Fax: 916-283-8815
Mailing address:
  • Phone: 916-283-8818
  • Fax: 916-283-8815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number54820
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20166
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: