Basic Information
Provider Information
NPI: 1003140161
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHEN
FirstName: HSIAO
MiddleName: CHEN
NamePrefix:  
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11 E BROADWAY
Address2: 13TH FLOOR
City: NEW YORK
State: NY
PostalCode: 100381013
CountryCode: US
TelephoneNumber: 8483911545
FaxNumber:  
Practice Location
Address1: 11 E BROADWAY
Address2: 13TH FLOOR
City: NEW YORK
State: NY
PostalCode: 100381013
CountryCode: US
TelephoneNumber: 8483911545
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/22/2009
LastUpdateDate: 10/27/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X054523NYY Dental ProvidersDentistGeneral Practice

No ID Information.


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