Healthcare Provider Details

I. General information

NPI: 1184142002
Provider Name (Legal Business Name): VICTOR CHIANG DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 08/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 BOWERY FL 6
NEW YORK NY
10002-4915
US

IV. Provider business mailing address

301 CATHEDRAL PKWY APT 5E
NEW YORK NY
10026-4061
US

V. Phone/Fax

Practice location:
  • Phone: 212-274-0477
  • Fax: 212-274-0499
Mailing address:
  • Phone: 917-442-1135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number059443
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: