Provider Demographics
NPI:1336768258
Name:CHIANG, CHIA-YUN (PHD, MED)
Entity Type:Individual
Prefix:
First Name:CHIA-YUN
Middle Name:
Last Name:CHIANG
Suffix:
Gender:F
Credentials:PHD, MED
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:
Other - Last Name:CHIANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3411 BERESFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-1301
Mailing Address - Country:US
Mailing Address - Phone:502-657-8619
Mailing Address - Fax:
Practice Address - Street 1:3301 E 12TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-3424
Practice Address - Country:US
Practice Address - Phone:502-657-8619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8191101YP2500X
221700000X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY163834OtherKENTUCKY BOARD OF LICENSED PROFESSIONAL COUNSELORS
KY163771OtherKENTUCKY BOARD OF LICENSURE FOR PROFESSIONAL ART THERAPISTS