Provider Demographics
NPI:1396756219
Name:CHAO, CHARLENE ZHIYI (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:ZHIYI
Last Name:CHAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 64TH STREET
Mailing Address - Street 2:STE 2F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5573
Mailing Address - Country:US
Mailing Address - Phone:718-833-2699
Mailing Address - Fax:718-833-2667
Practice Address - Street 1:802 64TH STREET
Practice Address - Street 2:STE 2F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5573
Practice Address - Country:US
Practice Address - Phone:718-833-2699
Practice Address - Fax:718-833-2667
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2024-12-23
Deactivation Date:2006-08-22
Deactivation Code:
Reactivation Date:2006-08-24
Provider Licenses
StateLicense IDTaxonomies
MA243672208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1396756219Medicaid
NY03128498Medicaid