Healthcare Provider Details

I. General information

NPI: 1891732863
Provider Name (Legal Business Name): YONGJIN CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: YONGJIN CHEN MD

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10803 MAIN ST
MANTUA OH
44255-9695
US

IV. Provider business mailing address

10803 MAIN ST
MANTUA OH
44255-8602
US

V. Phone/Fax

Practice location:
  • Phone: 330-274-2030
  • Fax: 330-274-2151
Mailing address:
  • Phone: 330-274-2030
  • Fax: 330-274-2151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-088152
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: