Provider Demographics
NPI:1942287792
Name:CHUANG, CHE-NAN (MD)
Entity Type:Individual
Prefix:
First Name:CHE-NAN
Middle Name:
Last Name:CHUANG
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 1:13347 SANFORD AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5800
Mailing Address - Country:US
Mailing Address - Phone:718-461-9779
Mailing Address - Fax:718-461-3454
Practice Address - Street 1:13347 SANFORD AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5800
Practice Address - Country:US
Practice Address - Phone:718-461-9779
Practice Address - Fax:718-461-3454
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2010-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198622207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01579482Medicaid
NY01579482Medicaid
NY01875Medicare ID - Type UnspecifiedGHI