Healthcare Provider Details

I. General information

NPI: 1003554601
Provider Name (Legal Business Name): CHIA-CHEN CHUANG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 S MAIN ST
MANCHESTER NH
03102-5143
US

IV. Provider business mailing address

775 S MAIN ST
MANCHESTER NH
03102-5143
US

V. Phone/Fax

Practice location:
  • Phone: 603-663-4040
  • Fax: 603-663-4044
Mailing address:
  • Phone: 603-663-4040
  • Fax: 603-663-4044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40010
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO4138
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: