Provider Demographics
NPI:1730313677
Name:CHIANG, CHUENCHIE (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:CHUENCHIE
Middle Name:
Last Name:CHIANG
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8760 CENTER PKWY
Mailing Address - Street 2:G343
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-8438
Mailing Address - Country:US
Mailing Address - Phone:702-677-2077
Mailing Address - Fax:
Practice Address - Street 1:8760 CENTER PKWY
Practice Address - Street 2:G343
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-8438
Practice Address - Country:US
Practice Address - Phone:702-677-2077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV57591223G0001X
CA602461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice