Healthcare Provider Details

I. General information

NPI: 1245261155
Provider Name (Legal Business Name): CHI CHAU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 W 11TH ST NR 1223
NEW YORK NY
10011-8305
US

IV. Provider business mailing address

153 W 11TH ST NR 1223
NEW YORK NY
10011-8305
US

V. Phone/Fax

Practice location:
  • Phone: 917-345-5091
  • Fax: 858-683-1871
Mailing address:
  • Phone: 917-345-5091
  • Fax: 858-683-1871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number228965
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: