Provider Demographics
NPI:1215038344
Name:CHAO, K. S. CLIFFORD CLIFFORD (MD)
Entity Type:Individual
Prefix:
First Name:K. S. CLIFFORD
Middle Name:CLIFFORD
Last Name:CHAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 WEST 168TH STREET
Mailing Address - Street 2:CHONY NORTH BSMT., RM 11
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3720
Mailing Address - Country:US
Mailing Address - Phone:212-305-9987
Mailing Address - Fax:212-305-0015
Practice Address - Street 1:622 WEST 168TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-9987
Practice Address - Fax:212-305-0015
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL63192085R0001X
NY251104-12085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX920007185OtherRAIL ROAD MEDICARE
TX8G5013OtherBCBSTX
TX1529460301Medicaid
NY03062131Medicaid
TX8G5013OtherBCBSTX
TX8801B7Medicare PIN
A4000023797Medicare PIN