Basic Information
| Provider Information | |||||||||
| NPI: | 1144227877 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUANG | ||||||||
| FirstName: | CHIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 855 MADISON ST | ||||||||
| Address2: | |||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603024420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084924077 | ||||||||
| FaxNumber: | 7083862839 | ||||||||
| Practice Location | |||||||||
| Address1: | 2701 W 68TH ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606291813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737354884 | ||||||||
| FaxNumber: | 7737352625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 07/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 036045227 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 036045227 | 05 | IL | MEDICAID | 1616108 | 01 | IL | BCBS | OTHER |