Provider Demographics
NPI:1841338639
Name:CHING JYGH CHEN
Entity type:Organization
Organization Name:CHING JYGH CHEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHING
Authorized Official - Middle Name:JYGH
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-984-5022
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:STE B319
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5037
Mailing Address - Fax:601-815-3773
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:STE B319
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5037
Practice Address - Fax:601-815-3773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08640332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00017570Medicaid
P00462169OtherRAILROAD MEDICARE
MS180000228Medicare PIN
MS512I180009Medicare PIN
MS00017570Medicaid
MSD00963Medicare UPIN