Provider Demographics
NPI:1912337593
Name:CHIA-HUNG YUAN DDS P.C.
Entity Type:Organization
Organization Name:CHIA-HUNG YUAN DDS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIA-HUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:YUAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-522-7483
Mailing Address - Street 1:136-20 38TH AVE.,
Mailing Address - Street 2:SUITE 5C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-661-1189
Mailing Address - Fax:
Practice Address - Street 1:136-20 38TH AVE.,
Practice Address - Street 2:SUITE 5C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-661-1189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02856619Medicaid