Provider Demographics
NPI:1417016221
Name:CHEN, YUCHUN (MD)
Entity Type:Individual
Prefix:
First Name:YUCHUN
Middle Name:
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 1:15 JEAN PL
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5914
Mailing Address - Country:US
Mailing Address - Phone:917-825-9391
Mailing Address - Fax:
Practice Address - Street 1:13633 37TH AVE
Practice Address - Street 2:SUITE 6A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4110
Practice Address - Country:US
Practice Address - Phone:917-825-9391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237534207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
08360GMedicare PIN