Healthcare Provider Details

I. General information

NPI: 1346165313
Provider Name (Legal Business Name): JIAHUI CHARMAINE CHAN MB CHB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

422 FRANKLIN ST APT 3
CAMBRIDGE MA
02139-3277
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number3019778
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: