Healthcare Provider Details

I. General information

NPI: 1245236165
Provider Name (Legal Business Name): CHRISTOPHER TAE-KYUNG CHIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 5TH AVE
NEW YORK NY
10021-2650
US

IV. Provider business mailing address

927 5TH AVE
NEW YORK NY
10021-2650
US

V. Phone/Fax

Practice location:
  • Phone: 212-517-6767
  • Fax: 212-737-6600
Mailing address:
  • Phone: 212-517-6767
  • Fax: 212-737-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number225031
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: