Provider Demographics
NPI:1235759812
Name:YUN & CHIN-TAN PHYSICIANS PLLC
Entity Type:Organization
Organization Name:YUN & CHIN-TAN PHYSICIANS PLLC
Other - Org Name:ELITE MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MON
Authorized Official - Last Name:CHIN-TAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:646-653-0889
Mailing Address - Street 1:14205 ROOSEVELT AVE APT 112
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6005
Mailing Address - Country:US
Mailing Address - Phone:718-663-2179
Mailing Address - Fax:631-684-2401
Practice Address - Street 1:14205 ROOSEVELT AVE APT 112
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6005
Practice Address - Country:US
Practice Address - Phone:718-663-2179
Practice Address - Fax:631-684-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-23
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03993033Medicaid