1699129536 NPI number — GORETTI CHIANG

Table of content: GORETTI CHIANG (NPI 1699129536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699129536 NPI number — GORETTI CHIANG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIANG
Provider First Name:
GORETTI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699129536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3401 CIVIC CENTER BLVD STE 9329
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19104-4319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-425-9300
Provider Business Mailing Address Fax Number:
267-425-9331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3401 CIVIC CENTER BLVD
Provider Second Line Business Practice Location Address:
DIVISION OF ANESTHESIOLOGY
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-590-4557
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  OS021128 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP3000X , with the licence number: OS021128 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)