Healthcare Provider Details

I. General information

NPI: 1730093790
Provider Name (Legal Business Name): PETERSON J. CHAO DDS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 FRANCIS LEWIS BLVD
FLUSHING NY
11358-1536
US

IV. Provider business mailing address

5014 48TH ST
WOODSIDE NY
11377-7332
US

V. Phone/Fax

Practice location:
  • Phone: 347-438-1177
  • Fax:
Mailing address:
  • Phone: 516-605-8784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. PETERSON CHAO
Title or Position: DENTIST
Credential: DDS
Phone: 516-605-8784