Provider Demographics
NPI:1255505632
Name:OTAKI, CHIYO (MD)
Entity Type:Individual
Prefix:
First Name:CHIYO
Middle Name:
Last Name:OTAKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4278 SUNNYDELL DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3552
Mailing Address - Country:US
Mailing Address - Phone:336-793-9226
Mailing Address - Fax:
Practice Address - Street 1:4278 SUNNYDELL DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3552
Practice Address - Country:US
Practice Address - Phone:336-793-9226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.014216207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology