Provider Demographics
NPI:1245236165
Name:CHIA, CHRISTOPHER TAE-KYUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:TAE-KYUNG
Last Name:CHIA
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 1:927 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2650
Mailing Address - Country:US
Mailing Address - Phone:212-517-6767
Mailing Address - Fax:212-737-6600
Practice Address - Street 1:927 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2650
Practice Address - Country:US
Practice Address - Phone:212-517-6767
Practice Address - Fax:212-737-6600
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225031208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1465F1Medicare ID - Type UnspecifiedPROVIDER NUMBER
H99864Medicare UPIN