=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427057884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEN L CHIANG MDPA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2005
-----------------------------------------------------
Last Update Date | 07/15/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13020 FORT KING RD STE 102
-----------------------------------------------------
City | DADE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33525-5222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-567-1367
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13020 FORT KING RD STE 102
-----------------------------------------------------
City | DADE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33525-5222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-567-1367
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BEN L CHIANG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 352-567-1367
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 26856
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------