Provider Demographics
NPI:1326159237
Name:CHIA, KIMBO B (M D, F A C S)
Entity Type:Individual
Prefix:
First Name:KIMBO
Middle Name:B
Last Name:CHIA
Suffix:
Gender:M
Credentials:M D, F A C S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1108
Mailing Address - Country:US
Mailing Address - Phone:716-332-0678
Mailing Address - Fax:716-332-0679
Practice Address - Street 1:564 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1108
Practice Address - Country:US
Practice Address - Phone:716-332-0678
Practice Address - Fax:716-332-0679
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204877208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01582998Medicaid
NY11680BMedicare ID - Type UnspecifiedMEDICARE NUMBER
NY01582998Medicaid