Healthcare Provider Details

I. General information

NPI: 1154321156
Provider Name (Legal Business Name): CHARLES CHIANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 HARPER DR NE
ALBUQUERQUE NM
87109-3566
US

IV. Provider business mailing address

8801 HORIZON BLVD NE SUITE 360
ALBUQUERQUE NM
87113-1533
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-5757
  • Fax: 505-865-0160
Mailing address:
  • Phone: 505-246-2622
  • Fax: 505-213-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD2004-0711
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: