Healthcare Provider Details

I. General information

NPI: 1861979833
Provider Name (Legal Business Name): CRYSTAL SIN YI CHEUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE # FEGAN4
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE # FEGAN4
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 857-472-2148
  • Fax:
Mailing address:
  • Phone: 617-355-6401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number277567
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: