Healthcare Provider Details

I. General information

NPI: 1124559091
Provider Name (Legal Business Name): CHEN YIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7595 ANAGRAM DR
EDEN PRAIRIE MN
55344-7399
US

IV. Provider business mailing address

7595 ANAGRAM DR
EDEN PRAIRIE MN
55344-7399
US

V. Phone/Fax

Practice location:
  • Phone: 612-573-2200
  • Fax: 612-573-2250
Mailing address:
  • Phone: 612-573-2200
  • Fax: 612-573-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301506427
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberS0129
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2026-01899
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4581708
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number81643
License Number StateMN
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD61411090
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: