Healthcare Provider Details

I. General information

NPI: 1245359405
Provider Name (Legal Business Name): JUDY CHIANG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E HAMPDEN AVE SUITE 350
ENGLEWOOD CO
80113-3781
US

IV. Provider business mailing address

PO BOX 64
ENGLEWOOD CO
80151-0064
US

V. Phone/Fax

Practice location:
  • Phone: 303-805-7686
  • Fax: 303-805-7732
Mailing address:
  • Phone: 303-805-7686
  • Fax: 303-805-7732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JUDY CHIANG
Title or Position: OWNER
Credential: MD
Phone: 303-788-1766