Basic Information
Provider Information | |||||||||
NPI: | 1073645560 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KUANG | ||||||||
FirstName: | QIAO TING | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KUANG | ||||||||
OtherFirstName: | TING | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 1250 HANCOCK ST | ||||||||
Address2: | INTERNAL MEDICINE | ||||||||
City: | QUINCY | ||||||||
State: | MA | ||||||||
PostalCode: | 021694339 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6177740840 | ||||||||
FaxNumber: | 6177740882 | ||||||||
Practice Location | |||||||||
Address1: | 1250 HANCOCK ST | ||||||||
Address2: | PRESIDENTS PLACE - SOUTH TOWER | ||||||||
City: | QUINCY | ||||||||
State: | MA | ||||||||
PostalCode: | 021694339 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6177740840 | ||||||||
FaxNumber: | 6177740882 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/10/2007 | ||||||||
LastUpdateDate: | 08/05/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | LP00491 | RI | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 231947 | MA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 2150891 | 05 | MA |   | MEDICAID |