Provider Demographics
NPI:1275625634
Name:CHEN, CHANG (KENNY) JIAN (FNP, BC)
Entity Type:Individual
Prefix:MR
First Name:CHANG (KENNY)
Middle Name:JIAN
Last Name:CHEN
Suffix:
Gender:M
Credentials:FNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 84TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2915
Mailing Address - Country:US
Mailing Address - Phone:917-282-7683
Mailing Address - Fax:
Practice Address - Street 1:2266 CROPSEY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5706
Practice Address - Country:US
Practice Address - Phone:718-266-6100
Practice Address - Fax:718-265-3344
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ14385Medicare UPIN
NY0548G1Medicare ID - Type Unspecified