Provider Demographics
NPI:1922803931
Name:CHIANG, SZU HUA
Entity type:Individual
Prefix:
First Name:SZU HUA
Middle Name:
Last Name:CHIANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S 43RD ST APT 401
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3195
Mailing Address - Country:US
Mailing Address - Phone:215-439-4561
Mailing Address - Fax:
Practice Address - Street 1:1902 N PROSPECT AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-1411
Practice Address - Country:US
Practice Address - Phone:217-204-9025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA616481551223E0200X
IL019.0356721223G0001X
IL021.0034091223E0200X
TX411691223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice