Healthcare Provider Details

I. General information

NPI: 1417609777
Provider Name (Legal Business Name): YI-CHEN CHIANG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N UNIVERSITY AVE
ANN ARBOR MI
48109-1078
US

IV. Provider business mailing address

350 THOMPSON ST APT 400
ANN ARBOR MI
48104-2279
US

V. Phone/Fax

Practice location:
  • Phone: 734-763-3325
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901601096
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: