Healthcare Provider Details

I. General information

NPI: 1033452867
Provider Name (Legal Business Name): YAXI CHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3014 37TH ST
ASTORIA NY
11103-3809
US

IV. Provider business mailing address

3014 37TH ST
ASTORIA NY
11103-3809
US

V. Phone/Fax

Practice location:
  • Phone: 718-278-9500
  • Fax:
Mailing address:
  • Phone: 718-278-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number277344
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: