Healthcare Provider Details

I. General information

NPI: 1013208883
Provider Name (Legal Business Name): ANGELINE CHIANG R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 GEORGIA AVE SE
ATLANTA GA
30312-2848
US

IV. Provider business mailing address

CMR 405 BOX 7709
APO AE
09034-0078
US

V. Phone/Fax

Practice location:
  • Phone: 404-608-8354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH010816
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: