Healthcare Provider Details

I. General information

NPI: 1124493929
Provider Name (Legal Business Name): TINA CHEN YAN MS,RDN, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 GRAND ST
NEW YORK NY
10002-3951
US

IV. Provider business mailing address

375 GRAND ST
NEW YORK NY
10002-3951
US

V. Phone/Fax

Practice location:
  • Phone: 212-260-3640
  • Fax:
Mailing address:
  • Phone: 212-260-3640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number008507
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number863887
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: