Provider Demographics
NPI:1063543692
Name:CHIANG, JOHN TAKAJARA (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TAKAJARA
Last Name:CHIANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10 WATERSIDE PLZ
Mailing Address - Street 2:APT. 3E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2602
Mailing Address - Country:US
Mailing Address - Phone:212-689-8940
Mailing Address - Fax:
Practice Address - Street 1:3811 BROADWAY
Practice Address - Street 2:3RD FLOOR STEINWAY COMMUNITY SERVICES
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4045
Practice Address - Country:US
Practice Address - Phone:718-726-5953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1977942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG48593Medicare UPIN