Healthcare Provider Details

I. General information

NPI: 1558761890
Provider Name (Legal Business Name): CHAN YEU PU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2014
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MALL RD
BURLINGTON MA
01805-0001
US

IV. Provider business mailing address

5000 KY ROUTE 321
PRESTONSBURG KY
41653-9113
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8000
  • Fax:
Mailing address:
  • Phone: 606-886-7645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number84537
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number84537
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number290558
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number290558
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125065720
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberTP294
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberTP294
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: