Healthcare Provider Details

I. General information

NPI: 1386770022
Provider Name (Legal Business Name): KATHY CHUANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY CHANG M.D.

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BROOKLINE AVE
BOSTON MA
02215-3904
US

IV. Provider business mailing address

133 BROOKLINE AVE
BOSTON MA
02215-3904
US

V. Phone/Fax

Practice location:
  • Phone: 617-421-1020
  • Fax:
Mailing address:
  • Phone: 617-421-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number242064
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number242064
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number242064
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: