Basic Information
| Provider Information | |||||||||
| NPI: | 1881859395 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHHEANG | ||||||||
| FirstName: | SOPHIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 208042 | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065208042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037855253 | ||||||||
| FaxNumber: | 2037853024 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 CEDAR ST # TE2 | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037855253 | ||||||||
| FaxNumber: | 2037853024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2008 | ||||||||
| LastUpdateDate: | 06/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | 265399 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0202X | 063700 | CT | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.