Healthcare Provider Details

I. General information

NPI: 1982799169
Provider Name (Legal Business Name): CHRISTINA YI CHIANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR SE 5TH FLOOR SUITE 5600 PMG CEDAR OBGYN
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-6000
  • Fax: 505-563-6060
Mailing address:
  • Phone: 505-923-5356
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number9927
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: