Provider Demographics
NPI:1730380676
Name:CHUANG, KENG-YU (MD)
Entity type:Individual
Prefix:DR
First Name:KENG-YU
Middle Name:
Last Name:CHUANG
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 1:13203 N 103RD AVE
Mailing Address - Street 2:SUITE C3
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3028
Mailing Address - Country:US
Mailing Address - Phone:623-972-2116
Mailing Address - Fax:
Practice Address - Street 1:13203 N 103RD AVE
Practice Address - Street 2:SUITE C3
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3028
Practice Address - Country:US
Practice Address - Phone:623-972-2116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430583207R00000X
AZ81994207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ561822Medicaid
AZ42546OtherSTATE LICENSE
AZ561822Medicaid