Healthcare Provider Details

I. General information

NPI: 1053557504
Provider Name (Legal Business Name): JENNIFER HINLU CHUANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD CHILDREN'S HOSPITAL OF PHILADELPHIA - ADOLESCENT MED
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

703 MAIN ST
PATERSON NJ
07503-2621
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-6864
  • Fax: 215-590-4708
Mailing address:
  • Phone: 973-754-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number25MA10350700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD446677
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: