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General NPI Number Information
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NPI Number | 1679245310
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Entity Type | Individual
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Provider Name | KELLY IRIS CHIANG
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Gender | Female
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Dates
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Enumeration Date | 09/30/2021
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 5850 E STILL CIR
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City | MESA
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State | AZ
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Zip | 85206-3618
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Country | US
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Telephone | 480-219-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 4222 ALEGRE WAY
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City | EL MACERO
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State | CA
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Zip | 95618-7129
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Country | US
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Telephone | 530-219-8128
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 62090
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License Number State | CA
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