Provider Demographics
NPI:1659536134
Name:YONG B. CHI, M.D., P.L.L.C.
Entity Type:Organization
Organization Name:YONG B. CHI, M.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YONG
Authorized Official - Middle Name:BAEK
Authorized Official - Last Name:CHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-778-9100
Mailing Address - Street 1:6040 EDWARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWFANE
Mailing Address - State:NY
Mailing Address - Zip Code:14108-1009
Mailing Address - Country:US
Mailing Address - Phone:716-778-9100
Mailing Address - Fax:716-778-9102
Practice Address - Street 1:6040 EDWARD AVE
Practice Address - Street 2:
Practice Address - City:NEWFANE
Practice Address - State:NY
Practice Address - Zip Code:14108-1009
Practice Address - Country:US
Practice Address - Phone:716-778-9100
Practice Address - Fax:716-778-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00930561Medicaid
NY005013Medicare PIN
NY00930561Medicaid
NY005015Medicare PIN