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General NPI Number Information
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NPI Number | 1063543692
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Entity Type | Individual
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Provider Name | JOHN TAKAJARA CHIANG M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3811 BROADWAY 3RD FLOOR STEINWAY COMMUNITY SERVICES
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City | ASTORIA
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State | NY
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Zip | 11103-4045
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Country | US
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Telephone | 718-726-5953
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Fax |
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Provider Business Mailing Address
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Address Line | 10 WATERSIDE PLZ APT. 3E
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City | NEW YORK
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State | NY
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Zip | 10010-2602
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Country | US
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Telephone | 212-689-8940
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 197794
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License Number State | NY
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