Provider Demographics
NPI:1790267094
Name:CHAO, YI LING (PA-C)
Entity type:Individual
Prefix:
First Name:YI LING
Middle Name:
Last Name:CHAO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PENNSYLVANIA AVE FL 7
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-2428
Mailing Address - Country:US
Mailing Address - Phone:646-979-8538
Mailing Address - Fax:
Practice Address - Street 1:101 PENNSYLVANIA AVE FL 7
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-2428
Practice Address - Country:US
Practice Address - Phone:646-979-8538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022435207R00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty