Basic Information
Provider Information
NPI: 1982870127
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHIANG
FirstName: DIAN
MiddleName: JUNG
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 25608
Address2:  
City: SALT LAKE CITY
State: UT
PostalCode: 841250608
CountryCode: US
TelephoneNumber: 2063204476
FaxNumber: 2065687043
Practice Location
Address1: 1221 MADISON ST STE 1220
Address2:  
City: SEATTLE
State: WA
PostalCode: 981041356
CountryCode: US
TelephoneNumber: 2062154250
FaxNumber: 2062154252
Other Information
ProviderEnumerationDate: 05/07/2008
LastUpdateDate: 07/08/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X127901NCN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000X35.097358OHN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RG0100XMD60555376WAY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

No ID Information.


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