Provider Demographics
NPI:1710183314
Name:CHEN, YANIV (MDCM)
Entity Type:Individual
Prefix:DR
First Name:YANIV
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MDCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2590 MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-5838
Mailing Address - Country:US
Mailing Address - Phone:203-377-5988
Mailing Address - Fax:203-380-0531
Practice Address - Street 1:99 HAWLEY LN
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1202
Practice Address - Country:US
Practice Address - Phone:203-377-5988
Practice Address - Fax:203-380-0531
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0511162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology