Provider Demographics
NPI:1669834552
Name:ROSSETTI-CHUNG, ALLEN YICHENG (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:YICHENG
Last Name:ROSSETTI-CHUNG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:ALLEN
Other - Middle Name:YICHENG
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:825 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5767
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:825 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5767
Practice Address - Country:US
Practice Address - Phone:401-437-5865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10166362085R0001X
MN553622085R0001X
PAMD4740592085R0001X
RIMD193832085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology