Healthcare Provider Details

I. General information

NPI: 1891163937
Provider Name (Legal Business Name): SANFORD MEDICAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2015
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13347 SANFORD AVE SUITE 1C
FLUSHING NY
11355-5800
US

IV. Provider business mailing address

13347 SANFORD AVE SUITE 1C
FLUSHING NY
11355-5800
US

V. Phone/Fax

Practice location:
  • Phone: 718-461-9779
  • Fax:
Mailing address:
  • Phone: 718-461-9779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHE-NAN CHUANG
Title or Position: OWNER
Credential: M.D.
Phone: 718-461-9779