Provider Demographics
NPI:1801071246
Name:KIM M. CHAU,D.M.D.,P.C.
Entity type:Organization
Organization Name:KIM M. CHAU,D.M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHAU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-440-8177
Mailing Address - Street 1:111 BOSTON POST RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2463
Mailing Address - Country:US
Mailing Address - Phone:978-440-8177
Mailing Address - Fax:978-440-8175
Practice Address - Street 1:111 BOSTON POST RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-2463
Practice Address - Country:US
Practice Address - Phone:978-440-8177
Practice Address - Fax:978-440-8175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty