Healthcare Provider Details

I. General information

NPI: 1043741754
Provider Name (Legal Business Name): YAN YU CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 09/24/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3869 HIGHWAY 81
LOGANVILLE GA
30052-3918
US

IV. Provider business mailing address

1051 CARROLL CT
NORCROSS GA
30071-5008
US

V. Phone/Fax

Practice location:
  • Phone: 770-466-3622
  • Fax:
Mailing address:
  • Phone: 678-575-8882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number305080-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number87661
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: