Provider Demographics
NPI:1639465784
Name:CHIANG, JER-WEI (DDS)
Entity type:Individual
Prefix:DR
First Name:JER-WEI
Middle Name:
Last Name:CHIANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13702 NORTHERN BLVD
Mailing Address - Street 2:APT 6C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13702 NORTHERN BLVD
Practice Address - Street 2:APT 6C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4322
Practice Address - Country:US
Practice Address - Phone:310-500-9822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
NY057638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program