Provider Demographics
NPI:1447367453
Name:CHIANG, VEN CHUNG (MD)
Entity type:Individual
Prefix:MR
First Name:VEN
Middle Name:CHUNG
Last Name:CHIANG
Suffix:
Gender:M
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:P.O. BOX 2267
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31604
Mailing Address - Country:US
Mailing Address - Phone:229-244-6544
Mailing Address - Fax:229-241-9744
Practice Address - Street 1:410 COWART AVE
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2622
Practice Address - Country:US
Practice Address - Phone:229-244-6544
Practice Address - Fax:229-241-9744
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054594207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA843869286AMedicaid
GRP6735Medicare ID - Type Unspecified
F67367Medicare UPIN