Healthcare Provider Details

I. General information

NPI: 1841338639
Provider Name (Legal Business Name): CHING JYGH CHEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST STE B319
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 N STATE ST STE B319
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5037
  • Fax: 601-815-3773
Mailing address:
  • Phone: 601-984-5037
  • Fax: 601-815-3773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number08640
License Number StateMS

VIII. Authorized Official

Name: DR. CHING JYGH CHEN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 601-984-5022