Healthcare Provider Details

I. General information

NPI: 1144227877
Provider Name (Legal Business Name): CHIA HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W 68TH ST
CHICAGO IL
60629-1813
US

IV. Provider business mailing address

855 MADISON ST
OAK PARK IL
60302-4420
US

V. Phone/Fax

Practice location:
  • Phone: 773-735-4884
  • Fax: 773-735-2625
Mailing address:
  • Phone: 708-492-4077
  • Fax: 708-386-2839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036045227
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: