Healthcare Provider Details

I. General information

NPI: 1114737756
Provider Name (Legal Business Name): AISHA CHIANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19415 DEERFIELD AVE, SUITE 213
LEESBURG VA
20176-1941
US

IV. Provider business mailing address

224D CORNWALL ST NW STE 403
LEESBURG VA
20176-2704
US

V. Phone/Fax

Practice location:
  • Phone: 703-729-9220
  • Fax: 703-858-3529
Mailing address:
  • Phone: 703-737-6010
  • Fax: 703-443-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011204
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: