Provider Demographics
NPI:1811227960
Name:KIMBO CHIA M.D., P.C.
Entity Type:Organization
Organization Name:KIMBO CHIA M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIMBO
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-332-0678
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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIMBO CHIA M.D.,P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204877NY208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty