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General NPI Number Information
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NPI Number | 1598768129
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Entity Type | Individual
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Provider Name | JONATHAN Y CHIANG DDS
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Gender | Male
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 03/25/2010
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Provider Practice Location Address
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Address Line | 9169 COORS RD. NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87193
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Country | US
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Telephone | 505-733-8440
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Fax |
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Provider Business Mailing Address
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Address Line | 6336 BOBCAT HILL PL. NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-8053
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Country | US
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Telephone | 808-554-1566
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019-026320
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5538443-9921/8903
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License Number State | UT
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