Provider Demographics
NPI:1073830790
Name:CHEN, TIMOTHY CHIN-YU (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CHIN-YU
Last Name:CHEN
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 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:901-227-3255
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:401 BAPTIST DR
Practice Address - Street 2:SUITE 104
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-2009
Practice Address - Country:US
Practice Address - Phone:601-605-2383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS22583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS22583OtherLICENSE NUMBER
NC164441OtherRESIDENT TRAINING LICENSE
NC164441OtherRESIDENT TRAINING LICENSE