Basic Information
| Provider Information | |||||||||
| NPI: | 1245344423 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHUANG | ||||||||
| FirstName: | CHENG-CHIEH | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 690067 | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022690067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088285020 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 416 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | RAYNHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027671737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088285020 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 05/23/2016 | ||||||||
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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 | 207Q00000X | 158428 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | BC 5739543 | 01 | DEA NUMBER | OTHER | 158428 | 01 | MA | STATE LICENSE | OTHER |