Healthcare Provider Details

I. General information

NPI: 1982281911
Provider Name (Legal Business Name): JACK CHIEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 CAMINO DE SALUD NE
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

UNM SCHOOL OF MEDICINE MSC08 4720 1 UNM
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2610
  • Fax: 505-272-1300
Mailing address:
  • Phone: 505-272-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOP61427421
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: