Basic Information
| Provider Information | |||||||||
| NPI: | 1780883835 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHIANG | ||||||||
| FirstName: | JING-TZYH | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Practice Location | |||||||||
| Address1: | 10700 E GEDDES AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2007 | ||||||||
| LastUpdateDate: | 04/07/2017 | ||||||||
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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 | 2085R0202X | MD18394 | HI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | A110622 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 53610 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 27901 | NE | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 04-37256 | KS | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 942933 | 05 | AZ | MEDICAID | 1780883835 | 05 | IA | MEDICAID | 1780883835 | 05 | MT | MEDICAID | 1780883835 | 05 | UT | MEDICAID | 201101030A | 05 | KS | MEDICAID | 10026277300 | 05 | NE | MEDICAID | 10026277600 | 05 | NE | MEDICAID | 10026277800 | 05 | NE | MEDICAID | 200551150A | 05 | OK | MEDICAID | 69157561 | 05 | NM | MEDICAID | 10025709000 | 05 | NE | MEDICAID | 10026277500 | 05 | NE | MEDICAID | 1780883835 | 05 | WY | MEDICAID | 61788261 | 05 | CO | MEDICAID | 10026277700 | 05 | NE | MEDICAID | 10026277400 | 05 | NE | MEDICAID |